PURPOSE
This review aimed to determine the effectiveness of oral care using Chlorhexidine Gluconate (CHX) in Ventilator-Associated Pneumonia (VAP) in the intensive care unit.
METHODS
An electronic databases search was conducted with Ovid-MEDLINE, EMBASE, CENTRAL, CINAHL and four domestic databases from July 10 to 16, 2018. Two reviewers independently selected the studies; three reviewers assessed their methodological quality and extracted relevant data. We conducted a meta-analysis of the effect of CHX oral care versus placebo using the Review Manager 5.3 software program and summarized the results of intervention from the included studies.
RESULTS
Of the 512 articles identified, 17 randomized controlled trials met the inclusion criteria for review. The incidence of VAP differed significantly between the CHX and placebo groups (Relative Risk [RR]=0.72, 95% Confidence Interval [CI]=0.63~0.84). The pooled effects of oral care using 0.12% CHX were RR=0.65 (95% CI=0.52~0.80) and RR=0.68 (95% CI=0.54~0.86) using CHX solution, which were statistically significant. When CHX oral care was performed three times a day, the size of the effect was statistically significant (RR=0.63, 95% CI=0.40~0.99). There was no significant difference in mortality between the CHX oral care and placebo groups (RR=1.08, 95% CI=0.94~1.28).
CONCLUSION
This review provides evidence that performing oral care using a 0.12% CHX solution three times a day could decrease the incidence of VAP. For improving the quality of nursing practice, the results of this review should be used as the basis for the oral care evidence-based practice guidelines for critical patients.

Citations

• Oral Hygiene Care of Endotracheal Intubated Patients in Korean Intensive Care Units : A Scoping Review
  Jungeun Lim, Dukyoo Jung, Leeho Yoo
  Journal of Korean Critical Care Nursing.2024; 17(1): 68.     CrossRef
• Effect of 2% Chlorhexidine Bathing on the Incidence of Hospital-Acquired Infection and Multidrug-Resistant Organisms in Adult Intensive Care Unit Patients: Systematic Review and Meta-Analysis
  Jisu Seo, Rhayun Song
  Journal of Korean Academy of Nursing.2021; 51(4): 414.     CrossRef

PURPOSE
This study was designed to investigate whether there were differences among three oral care protocols on participants' oral health status (oral status, dry mouth, halitosis, saliva pH, microorganism growth in oral cavity) and tooth stain. The three protocols were: 1) oral solution of 4% normal saline, 2) 0.1% Chlorhexidine and 3) Tantum.
METHODS
A nonequivalent control group pretest-posttest design was utilized. A total of 55 elderly patients residing at long-term care facilities(19 in the 4% normal saline group, 17 in the 0.1% Chlorhexidine group, 19 in the Tantum group) received oral care daily for four weeks. Data were analyzed using SPSS/WIN 22.0 program.
RESULTS
The halitosis (χ²=10.71, p=.005) and saliva pH (χ²=6.84, p=.033) scores were significantly improved after the oral care with 4% normal saline.
CONCLUSION
These findings indicate that if elderly patients in long-term care facilities have complaint of the discomfort of using Chlorhexidine or Tantum, 4% normal saline is as effective at the other two. This can also be cost effective as there were no differences among the protocols in oral status, dry mouth, tooth stain or microorganism growth in oral cavity.

Citations

• Antibacterial and Cytotoxic Evaluation of Lespedeza cuneata Extract Against Periodontal Pathogens and Human Gingival Cells: A Novel Option for Periodontal Therapy
  Hyo-Ju Yoon, Gyoo-Cheon Kim, Seoul-Hee Nam
  Applied Sciences.2024; 15(1): 190.     CrossRef
• The impact of aromatherapy-based oral care on oral conditions, salivary pH, and halitosis in older adults with dementia: Pilot study
  Ae Kyung Chang, Bo kyoung Kim, Ah Young Kim
  Geriatric Nursing.2023; 53: 109.     CrossRef
• Comparison of the effects of two oral cares on thirst and oral status following nasal surgery: Oral swab versus non-swab using cold water gauze
  Anna Gu, Mi Yu, Youngjin Kim, Suyeon Park, Kyunghee Baek, Taehee Kim
  The Journal of Korean Academic Society of Nursing Education.2022; 28(3): 317.     CrossRef

PURPOSE
This study examined the effects of a program designed to prevent ventilator-associated pneumonia (VAP) on VAP rate and endotracheal colonization. The program focused on aspiration prevention and oral care.
METHODS
A nonequivalent control group post-test only design was utilized. One hundred patients admitted to a medical intensive care unit (MICU) or coronary care unit (CCU) were assigned to either a experimental group (n=50) or a control group (n=50). The participants were selected 48 hours following an endotracheal intubation. VAP prevention program given to the experimental group includes keeping the head of the bed to 30°~45° high, maintaining continuous endotracheal cuff pressure at 25 cm H₂O, performing endotracheal suction before change position, and providing oral care with 0.1% chlorhexidine every four hours. The control group received usual care. Data were analyzed using t-test, x² test, Mantel-Haenszel x² and Cox proportional harzard regression model.
RESULTS
The experimental group showed a lower VAP rate than the control group although the difference was not statistically significant (x²=0.79, p=.375). The experimental group showed lower colonization in tracheal secretion than the control group (x²=14.59, p<.001).
CONCLUSION
Results showed that a VAP prevention program is effective in reducing colonization of tracheal secretion. Therefore, VAP prevention programs are recommended as an ICU nursing intervention.

Citations

• Effects of Oral Care Using Chlorhexidine Gluconate on Ventilator-associated Pneumonia and Mortality: A Systematic Review and Meta-analysis
  Nam Young Kim, Seang Ryu, Yun-Hee Kim
  Korean Journal of Adult Nursing.2019; 31(2): 109.     CrossRef