Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates
Moule, P. (2011) Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates. Nursing in Critical Care, 16 (6). pp. 295-301. ISSN 1362-1017
Publisher's URL: http://dx.doi.org/10.1111/j.1478-5153.2011.00465.x
Background: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth brushing has been considered as a clinical intervention to reduce infection rates however evidence to inform this needs appraising. Aim: This paper presents a critical review on whether chlorhexidine gluconate (CHX) and tooth-brushing decreases rates of ventilator-associated pneumonia in adult mechanically ventilated patients cared for in intensive care settings. Methods: A literature search was conducted using a number of bibliographic databases (n=6). A number of parameters were used to exclude irrelevant papers. A total n=17 papers were located and accessed which were directly related to the field. Findings: CHX was successful in reducing the rate of VAP and using a combination of CHX and colistine resulted in better oropharyngeal decontamination which reduced and delayed VAP. Chlorhexidine was also effective in reducing dental plaque in patients cared for in intensive care and had the potential to reduce nosocomial infections. Results of studies investigating the use of tooth-brushing in reducing VAP incidence proved inconsistent, although all recommend tooth-brushing in maintaining good hygiene. Conclusions: The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram-negative bacteria.Tooth-brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggests that further research is required into the effects of tooth-brushing.
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