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 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

PURPOSE
Aspiration pneumonia (AP) is the major complication of dysphagia in patients with acute stroke. Nursing management for dysphagia influences on patients' health outcomes. The purpose of this study was to develop and evaluate the effects of Dysphagia Nursing Protocol (DNP) for patients with acute stroke. We aimed to examine the incidence of AP and the dependency rate at the discharge.
METHODS
We used a non-equivalent control group posttest only design in this study. DNP was developed with content validity index > 0.75 in all items. This protocol was composed of the evaluation, education, complication prevention, and checking phases. After training the staff nurses, we applied DNP protocol to the experimental group. The control group was enrolled from June to August 2013 (n=80), and the experimental group was June to August 2014 (n=64).
RESULTS
The incidence of AP was 16.3% in control group while 4.7% in experimental group (p=.028), and the Odds Ratio (OR) was 0.26 (p=.045). The dependency ratio was 66.3% in control group while 43.8% in experimental group (p=.011), and the OR was 0.33 (p=.011).
CONCLUSION
DNP was beneficial for the reducing the risk of AP and the improved the functional status.

Citations

• Dysphagia and daily oral fluids among cerebrovascular stroke patients: an theory-based nursing intervention protocol
  Zeinab Hussein Ali, Marwa Abd-Elaziz, Amany Abdrbo
  Frontiers of Nursing.2023; 10(2): 213.     CrossRef

PURPOSE
This study developed and evaluated a systematic intervention among medical ICU nurses for preventing ventilator-associated pneumonia (hereafter VAP).
METHODS
A VAP prevention program was proposed based on a literature review, revised to fit the target situation, and validated. It was composed of one-time interventions including education, pamphlets, hand cultures, and a quiz event, as well as repeated interventions such as posters, reminders, posting hand culture results, and performance feedback. A simulated control group pretest-posttest design was used to verify the effectiveness of the VAP control program. The incidence of VAP among ICU patients was measured both during 3 months before (n = 80) and during 3 months after (n = 75) intervention.
RESULTS
The VAP prevention program's effectiveness, with a pre-intervention VAP rate of 17.38 and post-intervention rate of 11.04 per 1,000 ventilator days, showed a clinical tendency to decrease, but the difference was not statistically significant (p = .750).
CONCLUSION
A VAP prevention program of multiple interventions can be useful in decreasing the VAP rate. Given that the monthly decrease in the VAP rate was not considered statistically significant, long-term research needs to be done. Additionally, since this study targeted only nurses, it is suggested that future research targets other health care workers who can influence VAP rates.

PURPOSE
This study was aimed at providing scientific evidence for minimizing ventilator-associated pneumonia(VAP) by identifying appropriate timing of exchange of circuit for mechanical ventilator that is well suitable for the medical environment of intensive care units of hospitals in Korea.
METHOD
This was a quasi-experimental study with a convenience sample of 19 adult subjects aged over 18 years who were admitted to the NS ICU of C university hospital, and placed on mechanical ventilator. The subjects were placed in two groups, compared on the incidence rate of VAP after they received exchange of circuit either at 1-week interval (N =10) or 2-week interval (N = 9).
RESULT
1) When considering 1000 days as the standard unit of analysis for incidence, the incidence rate of VAP was 7.19 cases at the 1-week cycle exchange group and 15.23 at the 2-week cycle exchange group, showing no statistically significant difference between the two groups. 2) There were a total of 3 types of bacteria isolated from the patients with VAP, including 2 cases with P. aeruginosa, 1 case with Streptococcus group F and A. baumannii.
CONCLUSION
With thorough hand washing and strict management of tracheal tube of mechanical ventilator as well as use of tracheal intubation techniques, exchange cycle of circuit of mechanical ventilator by nurses may be changed from 1-week to 2-week interval.