The aim of this systematic review was to determine the effect of chlorhexidine at different concentration and frequency on ventilator-associated pneumonia and microbial colonization in mechanically ventilated patients. Relevant studies in English language were identified by searching data bases between January 2010 and December 2017. Ten studies met the inclusion criteria. Chlorhexidine with 0.2% concentration was found to be more effective than the control group (placebo dental gel and normal saline) in preventing the development of ventilator-associated pneumonia in three of the eight studies. Twice-daily application was found to be effective reducing the rate of ventilator-associated pneumonia in three studies using 0.2% and 2% chlorhexidine. Microbial colonization was found to be less in 2% chlorhexidine group than herbal mouth wash 0.9% NaCl and 0.2% chlorhexidine in three studies. Chlorhexidine is an effective intervention in oral care for ventilator-associated pneumonia and microbial colonization.
AACN Practice Alert. (2017). Prevention of ventilator-associated pneumonia in adults. Critical Care Nurse, 37, e22-e25. doi:10.4037/ccn2017460
2.
AndrewsT.SteenC. (2013). A review of oral preventative strategies to reduce ventilator-associated pneumonia. Nursing in Critical Care, 18, 116-122. doi:10.1111/nicc.12002
3.
AtayS.KarabacakÜ. (2014). Oral care in patients on mechanical ventilation in intensive care unit: Literature review. International Journal of Research in Medical Sciences, 2, 822-829.
4.
AzimiM.JouybariL.MoghadamS.GhaemiE.BehnampoorN.SanagooA.HesaM. (2016). Antimicrobial effects of chlorhexidine, matrica drop mouthwash (chamomile extract), and normal saline on hospitalized patients with endotracheal tubes. Iranian Journal of Nursing and Midwifery Research, 21, 458-463.
5.
BaradariG. A.KhezriD. H.ArabiS. (2012). Comparison of antibacterial effects of oral rinses chlorhexidine and herbal mouth wash in patients admitted to intensive care unit. Bratislavske Lekarske Listy, 113, 556-560.
6.
BerryA. M.DavidsonP. M.MastersJ.RollsK.OllertonR. (2011). Effects of three approaches to standardized oral hygiene to reduce bacterial colonization and ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. International Journal of Nursing Studies, 48, 681-688. doi:10.1016/j.ijnurstu.2010.11.004
7.
CabovT.MacanD.HusedzinovicI.Skrlin-SubicJ.BosnjakD.Sestan-CrnekS.. . . GolubovicV. (2010). The impact of oral health and 0.2% chlorhexidine oral gel on the prevalence of nosocomial infections in surgical intensive-care patients: A randomized placebo-controlled study. Wiener Klinische Wochenschrift, 122, 397-404. doi:10.1007/s00508-010-1397-y
8.
Darvishi KhezriH.Emami ZeydiA.FirouzianA.Gholipour BaradariA.MahmoodiG.Hasanzadeh KiabiF.MoghaddasifarI. (2014). The importance of oral hygiene in prevention of Ventilator-Associated Pneumonia (VAP): A literature review. International Journal of Caring Sciences, 7, 12-23.
9.
El-RabbanyM.ZaghlolN.BhandariM.AzarpazhoohA. (2015). Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: A systematic review. International Journal of Nursing Studies, 52, 452-464. doi:10.1016/j.ijnurstu.2014.07.010
10.
GrapM. J.MunroC. L.HamiltonV. A.ElswickR. K.Jr.SesslerC. N.WardK. R. (2011). Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart & Lung, 40, e115-e122. doi:10.1016/j.hrtlng.2011.01.006
11.
HaghighiA.Baghari-NesamiM.BaradariA. G.CharatiJ. Y. (2017). The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients. Australian Critical Care, 30, 69-73. doi:10.1016/j.aucc.2016.07.002
12.
HigginsJ. P. T.AltmanD. G.GotzscheP. C.JüniP.MoherD.OxmanA. D.. . . SterneJ. A. C. (2011). The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. British Medical Journal, 343, Article d5928. doi:10.1136/bmj.d5928
13.
HillierB.WilsonC.ChamberlainD.KingL. (2013). Preventing ventilator-associated pneumonia through oral care, product selection, and application method: A literature review. AACN Advanced Critical Care, 24, 38-58. doi:10.1097/NCI.0b013e31827df8ad
14.
HuaF.XieH.WorthingtonH. V.FurnessS.ZhangQ.LiC. (2016). Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. The Cochrane Database of Systematic Reviews, 10, Article CD008367.
15.
KandeelN.TantawyN. (2012). Current nursing practice for prevention of ventilator associated pneumonia in ICUs. Life Science Journal, 9, 966-975.
16.
KlompasM.SpeckK.HowellM. D.GreeneL. R.BerenholtzS. M. (2014). Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: Systematic review and meta-analysis. JAMA Internal Medicine, 174, 751-761. doi:10.1001/jamainternmed.2014.359
17.
MattaA. S. (2015). Prevention of ventilation associated pneumonia, new ideas and better results. Journal of Pulmonary and Respiratory Medicine, 5, Article 240. doi:10.4172/2161-105X.1000240
18.
MeinbergM. C. A.CheadeM. F. M.MirandaA. L. D.FachiniM. M.LoboS. M. (2012). The use of 2% chlorhexidine gel and toothbrushing for oral hygiene of patients receiving mechanical ventilation: Effects on ventilator-associated pneumonia. Revista Brasileira de Terapia Intensiva, 24, 369-374.
19.
MunroN.RuggieroM. (2014). Ventilator-associated pneumonia bundle: Reconstruction for best care. AACN Advanced Critical Care, 25, 163-175; 176-178. doi:10.1097/NCI.0000000000000019
20.
ÖzçakaÖ.BaşoğluÖ. K.BuduneliN.TaşbakanM. S.BacakoğluF.KinaneD. F. (2012). Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: A randomized clinical trial. Journal of Periodontal Research, 47, 584-592. doi:10.1111/j.1600-0765.2012.01470.x
21.
ParM.BadovinacA.PlancakD. (2014). Oral hygiene is an important factor for prevention of ventilator-associated pneumonia. Acta Clinica Croatica, 53, 72-78.
22.
SharmaS. K.KaurJ. (2012). Randomized control trial on efficacy of chlorhexidine mouth care in prevention of Ventilator Associated Pneumonia (VAP). Nursing and Midwifery Research Journal, 8, 169-177.
23.
TuonF. F.GavrilkoO.de AlmeidaS.SumiE. R.AlbertoT.RochaJ. L.RosaE. A. (2017). Prospective, randomised, controlled study evaluating early modification of oral microbiota following admission to the intensive care unit and oral hygiene with chlorhexidine. Journal of Global Antimicrobial Resistance, 8, 159-163. doi:10.1016/j.jgar.2016.12.007
24.
VidalC. F.VidalA. K.MonteiroJ. G.Jr.CavalcantiA.HenriquesA. P.OliveiraM.. . . LacerdaH. R. (2017). Impact of oral hygiene involving toothbrushing versus chlorhexidine in the prevention of ventilator-associated pneumonia: A randomized study. BMC Infectious Diseases, 17, Article 173. doi:10.1186/s12879-017-2273-4
25.
ZandF.ZahedL.MansouriP.DehghanradF.BahraniM.GhorbaniM. (2017). The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults’ intensive care units. Journal of Critical Care, 40, 318-322. doi:10.1016/j.jcrc.2017.02.029
26.
ZhangT. T.TangS. S.FuL. J. (2014). The effectiveness of different concentrations of chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis. Journal of Clinical Nursing, 23, 1461-1475. doi:10.1111/jocn.12312
