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Does oral care with chlorhexidine reduce ventilator-associated pneumonia in mechanically ventilated adults?

13 June 2019

Clinical

02 June 2019

Volume 28 · Issue 11

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Oral colonisation by pathogens contributes to contracting ventilator-associated pneumonia (VAP). The aim of this review was to determine whether the use of the antiseptic chlorhexidine in the intra-oral cavity reduced its incidence in the critically ill, mechanically ventilated adult. The findings from this review led to the conclusion that chlorhexidine reduced the occurrence of VAP. Although a recommendation to implement the use of intra-oral chlorhexidine for mechanically-ventilated patients within critical care can be made, further exploration into required frequency and method of administration would be beneficial to reduce unnecessary exposure and hinder pathogenic resistance.

Ventilator-associated pneumonia (VAP) is a nosocomial infection that occurs at least 48 hours after intubation in mechanically ventilated adult patients when respiratory and gastric fluid containing micro-organisms is aspirated into the lower respiratory tract and lung field, enabled by the presence of an endotracheal tube (Figure 1). Intubation interrupts the mechanical immune defences of the oropharynx and allows highly antibiotic-resistant infection into the pulmonary system.

Higher rates of morbidity and mortality, increased ventilation time and length of hospital stay are all associated with VAP, and thus the harm to patients and the cost to society are undeniable. Although data for the UK are not currently available, the World Health Organization (WHO) (2010) has suggested that VAP accounts for a 27.5% increase in mortality in critically ill adults across the developing world; hence, it is a global problem. Further data reveal that VAP occurs in 9–27% of intubated patients and extends stays in intensive care units (ICUs) by an average of 6 days (National Institute for Health and Care Excellence (NICE), 2007), signifying that a reduction in its prevalence is imperative.

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Adult

Ventilator-associated pneumonia

Oropharynx

Chlorhexidine

Critical care