Hostname: page-component-745bb68f8f-b6zl4 Total loading time: 0 Render date: 2025-02-05T07:36:28.081Z Has data issue: false hasContentIssue false
  • English
  • Français

Randomized Controlled Trial and Meta-analysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of Ventilator-Associated Pneumonia

Published online by Cambridge University Press:  02 January 2015

Hutsaya Tantipong ,
Chantana Morkchareonpong ,
Songyod Jaiyindee  and
Visanu Thamlikitkul
Hutsaya Tantipong
Affiliation:
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chantana Morkchareonpong
Affiliation:
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Songyod Jaiyindee
Affiliation:
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Visanu Thamlikitkul*
Affiliation:
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*
Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand (sivth@mahidol.ac.th)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the effectiveness of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia (VAP).

Design.

Randomized controlled trial and meta-analysis.

Setting.

A tertiary care university hospital in Bangkok, Thailand.

Participants.

Adult patients who received mechanical ventilation and who were hospitalized in intensive care units and general medical wards.

Methods.

The patients were randomized to receive oral decontamination with 2% chlorhexidine solution or normal saline solution 4 times per day until their endotracheal tubes were removed. The outcome measures were the development of VAP and oropharyngeal colonization with gram-negative bacilli. Meta-analysis was performed by combining the results of the present study with those from another randomized controlled trial that also used a 2% chlorhexidine formulation for oral decontamination.

Results.

The characteristics of the patients in the chlorhexidine group (n = 102) and the normal saline group (n = 105) were not significantly different. The incidence of VAP in the chlorhexidine group was 4.9% (5 of 102), and the incidence in the normal saline group was 11.4% (12 of 105) (P = .08). The rate of VAP in the chlorhexidine group was 7 episodes per 1,000 ventilator-days, and the rate in the normal saline group was 21 episodes per 1,000 ventilator-days (P = .04). Irritation of the oral mucosa was observed in 10 (9.8%) of the patients in the chlorhexidine group and in 1 (0.9%) of the patients in the normal saline group (P = .001). Oropharyngeal colonization with gram-negative bacilli was either reduced or delayed in the chlorhexidine group. Overall mortality of the patients did not differ significantly between the groups. Meta-analysis of 2 randomized controlled trials revealed an overall relative risk of VAP for patients in the chlorhexidine group of 0.53 (95% confidence interval, 0.31-0.90; P = .02).

Conclusion.

Oral decontamination with 2% chlorhexidine solution is an effective and safe method for preventing VAP in patients who receive mechanical ventilation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 2 , February 2008 , pp. 131 - 136
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Vincent, JL, Bihari, DJ, Suter, PM, et al.The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of infection in Intensive Care (EPIC) Study: EPIC International Advisory Committee. JAMA 1995;274:639–644.CrossRefGoogle Scholar
2.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crif Care Med 1999;27:887–892.Google Scholar
3.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
4.Safdar, N, Dezfulian, C, Collard, HR, Saint, S. Clinical and economic consequences of ventilator-associated pneumonia: a systematic review. Crit Care Med 2005;33:2184–2193.CrossRefGoogle ScholarPubMed
5.Danchaivijitr, S, Dhiraputra, C, Santiprasitkul, S, Judaeng, T. Prevalence and impacts of nosocomial infection in Thailand 2001. J Med Assoc Thai 2005;88(suppl 10):S1–S9.Google Scholar
6.Garrouste-Orgeas, M, Chevret, S, Arlet, G, et al.Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients: a prospective study based on genomic DNA analysis. Am J Respir Crit Care Med 1997;156:1647–1655.Google Scholar
7.Garcia, R. A review of the possible role of oral and dental colonization on the occurrence of health care-associated pneumonia: underappreciated risk and a call for interventions. Am J Infect Control 2005;33:527–541.Google Scholar
8.Bergmans, DC, Bonten, MJ, Gaillard, CA, et al.Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study. Am J Respir Crit Care Med 2001;164:382–388.CrossRefGoogle ScholarPubMed
9.Kollef, M, Pittet, D, Sanchez Garcia, M, et al.A randomized double-blind trial of iseganan in prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006;173:91–97.Google Scholar
10.Laggner, AN, Tryba, M, Georgopoulos, A, et al.Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate? Wien Klin Wochenschr 1994;106:15–19.Google ScholarPubMed
11.Rios, F, Maskin, B, Sanez, VA. Prevention of ventilator associated pneumonia by oral decontamination: prospective, randomized, double-blind, placebo controlled study. In: Program and abstracts of the American Thoracic Society International Conference (San Diego). 2005. C95. Poster 608.Google Scholar
12.DeRiso, AJ 2nd, Ladowski, JS, Dillon, TA, Justice, JW, Peterson, AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996; 109:1556–1561.CrossRefGoogle ScholarPubMed
13.Fourrier, F, Cau-Pottier, E, Boutigny, H, Roussel-Delvallez, M, Jourdain, M, Chopin, C. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill patients. Intensive Care Med 2000;26:1239–1247.Google Scholar
14.Fourrier, F, Dubois, D, Pronnier, P, et al.Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 2005;33:1728–1735.CrossRefGoogle ScholarPubMed
15.MacNaughton, PD, Bailey, J, Donlin, N, Branfield, P, Williams, A, Rowswell, H. A randomised controlled trial assessing the efficacy of oral Chlorhexidine in ventilated patients. European Society of Intensive Care Medicine, 17th Annual Congress, Berlin, Germany. Intensive Care Med 2004;30(suppl):S5–S18.Google Scholar
16.Houston, S, Hougland, P, Anderson, JJ, LaRocco, M, Kennedy, V, Gentry, LO. Effectiveness of 0.12% Chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002;11:567–570.CrossRefGoogle ScholarPubMed
17.Grap, MJ, Munro, CL, Elswick, RK Jr, Sessler, CN, Ward, KR. Duration of action of a single, early oral application of Chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study. Heart Lung 2004;33:83–91.CrossRefGoogle ScholarPubMed
18.Guideline for the Prevention of Healthcare-Associated Pneumonia, 2004. Atlanta, GA: Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee; 2004.Google Scholar
19.Chlebicki, MP, Safdar, N. Topical Chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2007;35: 595–602.Google Scholar
20.Chan, EY, Ruest, A, Meade, MO, Cook, DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334:889–899.CrossRefGoogle ScholarPubMed
21.Kola, A, Gastmeier, P. Efficacy of oral Chlorhexidine in preventing lower respiratory tract infections: meta-analysis of randomized controlled trials. J Hosp Infect 2007;66:207–216.CrossRefGoogle ScholarPubMed
22.Koeman, M, van der Ven, AJ, Hak, E, et al.Oral decontamination with Chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006;173:1348–1355.CrossRefGoogle ScholarPubMed
23.Denton, GW. Chlorhexidine. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia, PA: Lea and Febiger; 1991.Google Scholar