Efficacy of a Chlorhexidine-Based Oral Prevention Protocol in Reducing Ventilator-Associated Pneumonia in Pediatrics: A Controlled Before-After Study

Abstract

Background

Ventilator-associated pneumonia (VAP) remains the second most common nosocomial infection in pediatric intensive care units, yet evidence-based prevention strategies specific to children remain limited.

Objective

To evaluate the efficacy of a multimodal VAP prevention bundle incorporating 0.12% chlorhexidine oral care in reducing VAP incidence among mechanically ventilated pediatric patients.

Methods

Controlled before-after study in the Gemelli PICU (January 2016-May 2019) including 162 patients aged <18 years requiring mechanical ventilation ≥48 h: 80 historical controls (2016-2017) and 82 in the intervention group (2018-2019). The bundle comprised age-stratified oral hygiene (0.12% chlorhexidine for age >2 years, saline for younger children), head-of-bed elevation 30°-40°, biweekly microbiological surveillance, and daily weaning assessment. Primary outcome was VAP incidence using CDC/NHSN criteria.

Results

Bundle implementation was associated with a 69.5% reduction in VAP incidence (20% to 6.1%, P = .01), decreasing from 3.3 to 1.0 VAP/100 ventilator-days. The number needed to treat was 7.2 patients. Protocol implementation reduced VAP risk (adjusted OR 0.23; 95% CI 0.07-0.81; P = .022). VAP-associated mortality was lower in the intervention group (0% vs 3.8% in controls). Duration of mechanical ventilation remained the strongest risk factor (OR 1.18 per day; 95% CI 1.08-1.29; P < .001). Pseudomonas aeruginosa was identified in 57.1% of VAP cases, with polymicrobial infections in 52.4%. All isolates remained antibiotic-susceptible.

Conclusions

Structured implementation of an evidence-based VAP bundle may contribute to significant reductions in preventable VAP in pediatric intensive care. While findings are promising, the modest sample size necessitates cautious interpretation and validation through larger multicenter studies.