The Effectiveness of Chlorhexidine in Prevention

Question: Describe the effectiveness of mouthwash using a chlorhexidine solutions in the adult patients in reducing the prevalence of ventilated associated pneumonia in adult ICU? Answer: The effectiveness of chlorhexidine in prevention of ventilator associated pneumonia Area of Practice Adult surgical intensive care unit with 100 beds in ICU and more than 1500 beds in the hospital. Type of research Randomized control trial were studied on critically ill patients that met the criteria for inclusion. Discussion - Mechanical ventilation is a major system of providing support used in around thirty percent of the patients admitted in the Intensive Care Unit (ICU). Around 9- 27% of these patients who are put on mechanical ventilators develop Ventilator Associated Pneumonia (VAP). And a more horrifying fact is that out of these patients the mortality rate for these patients is as high as 33-50%. If the patient is on mechanical ventilator for 48 hours or more after intubation and previously did not have the disease, then he can be said to have developed Ventilator Associated Pneumonia. Cause - In 50% of the patients developing respiratory infection, the pathogen responsible for VAP is the same as found at the gingivo-dental level. Therefore the teeth are become a major reservoir for the pathogens and decontamination of the area with antibacterial-antiseptic solution like chlorhexidine will help to reduce the incidence of the disease. Chlorhexidine is a cationic chloro-phenylbis-biguanide antiseptic agent which binds to the oral tissue and slowly releases the antiseptic solution causing long period of antibacterial action because of which it is used in ICU patients. Results - Randomized control trials(RCT) to investigate effectiveness of use of chlorhexidine in preventing VAP in adult patients versus control or other placebos conclude that there was 36% higher incidence of VAP in ICU patients in control group than the patients receiving chlorhexidine. We may also conclude that 2% chlorhexidine is most effective in reducing the development of VAP. A meta-analysis also concluded that chlorhexidine is a safe and cost effective antiseptic in preventing VAP in adult ventilated patients in ICU. References 1. Snyders,O Khondowe,O Bell,J, Oral chlorhexidine in the prevention of ventilatoe associated pneumonia in critically ill adults in the ICU: a systematic review, SAJCC, November 2011, Vol 27 No. 2, Pg 48-562. Balamurgan,E Kanimozhi,A Kumari,G, Effectiveness of chlorhexidine oral decontamination in reducing the incidence of ventilator associated pneumonia: a meta-analysis, March 2012, British journal of medical practioners, Vol 5 No 1 Pg 6-103. Berry,A Davidson,P Masters,J Rolls,K Systematic literature: review of oral hygiene practices for intensive care patients receiving mechanical ventilation, November 2007, Vol 16 No 6 Pg 552-5624. Safdar,N Dezfulian,C Collard,H Saint,S, Clinical and economic consequences of ventilator-associated pneumonia: a systematic review, 2005, Vol 33 No 10 Pg 2184-2193 5. Sharma,S Kaur,J, Randomized control trial on efficacy of chlorhexidine mouth care in prevention of ventilator associated pneumonia(VAP),April 2012, Nursing and midwifery research journal, Vol 8 No 2 Pg 169-178