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Am J Crit Care. 2009 Sep;18(5):428-37; quiz 438. doi: 10.4037/ajcc2009792.

Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults.

Author information

1
Adult Health Department, School of Nursing, Virginia Commonwealth University, Richmond, Virginia 23298-0567, USA. cmunro@vcu.edu

Abstract

BACKGROUND:

Ventilator-associated pneumonia is associated with increased morbidity and mortality.

OBJECTIVE:

To examine the effects of mechanical (toothbrushing), pharmacological (topical oral chlorhexidine), and combination (toothbrushing plus chlorhexidine) oral care on the development of ventilator-associated pneumonia in critically ill patients receiving mechanical ventilation.

METHODS:

Critically ill adults in 3 intensive care units were enrolled within 24 hours of intubation in a randomized controlled clinical trial with a 2 x 2 factorial design. Patients with a clinical diagnosis of pneumonia at the time of intubation and edentulous patients were excluded. Patients (n = 547) were randomly assigned to 1 of 4 treatments: 0.12% solution chlorhexidine oral swab twice daily, toothbrushing thrice daily, both toothbrushing and chlorhexidine, or control (usual care). Ventilator-associated pneumonia was determined by using the Clinical Pulmonary Infection Score (CPIS).

RESULTS:

The 4 groups did not differ significantly in clinical characteristics. At day 3 analysis, 249 patients remained in the study. Among patients without pneumonia at baseline, pneumonia developed in 24% (CPIS >or=6) by day 3 in those treated with chlorhexidine. When data on all patients were analyzed together, mixed models analysis indicated no effect of either chlorhexidine (P = .29) or toothbrushing (P = .95). However, chlorhexidine significantly reduced the incidence of pneumonia on day 3 (CPIS >or=6) among patients who had CPIS <6 at baseline (P = .006). Toothbrushing had no effect on CPIS and did not enhance the effect of chlorhexidine.

CONCLUSIONS:

Chlorhexidine, but not toothbrushing, reduced early ventilator-associated pneumonia in patients without pneumonia at baseline.

PMID:
19723863
PMCID:
PMC3722581
DOI:
10.4037/ajcc2009792
[Indexed for MEDLINE]
Free PMC Article
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