Effect of Oral Hygiene with 0.12% Chlorhexidine Gluconate on the Incidence of Nosocomial Pneumonia in Children Undergoing Cardiac Surgery

• Published in: Infection control and hospital epidemiology Vol. 32; no. 6; pp. 591 - 596
• Main Authors: Jácomo, Andréa D. N., Carmona, Fabio, Matsuno, Alessandra K., Manso, Paulo H., Carlotti, Ana P. C. P.
• Format: Journal Article
• Language: English
• Published: Chicago, IL University of Chicago Press 01-06-2011
• Subjects: Bacterial pneumonia; Biological and medical sciences; Chi-Square Distribution; Child; Child health services; Child, Preschool; Chlorhexidine - analogs & derivatives; Chlorhexidine - therapeutic use; Cross Infection - epidemiology; Cross Infection - prevention & control; Dosage; Double-Blind Method; Female; General aspects; Heart Defects, Congenital - surgery; Human infectious diseases. Experimental studies and models; Humans; Incidence; Infant; Infant, Newborn; Infections; Infectious diseases; Intensive Care Units, Pediatric; Length of Stay; Logistic Models; Male; Medical sciences; Miscellaneous; Mouthwashes - therapeutic use; Nursing; Operating rooms; Oral hygiene; Oral Hygiene - methods; Original Article; Pediatric intensive care units; Placebos; Pneumology; Pneumonia; Pneumonia, Bacterial - epidemiology; Pneumonia, Bacterial - etiology; Pneumonia, Bacterial - prevention & control; Pneumonia, Ventilator-Associated - epidemiology; Pneumonia, Ventilator-Associated - etiology; Pneumonia, Ventilator-Associated - prevention & control; Public health. Hygiene; Public health. Hygiene-occupational medicine; Respiration, Artificial - adverse effects; Respiratory system : syndromes and miscellaneous diseases; Statistics, Nonparametric; Time Factors; Ventilator associated pneumonia; Human; Lung disease; Nosocomial infection; Pneumonia; Respiratory disease; Guanidines; Cardiac surgery; Epidemiology; Incidence; Oral cavity; Biguanides; Antiseptic; Chlorhexidine; Disinfecting agent; Child; Public health
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/660018

Objective. To evaluate the effect of oral hygiene with 0.12% chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.
Design. Prospective, randomized, double-blind, placebo-controlled trial.
Setting. Pediatric intensive care unit (PICU) at a tertiary care hospital.
Patients. One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: chlorhexidine (
) and control (
).
Interventions. Oral hygiene with 0.12% chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.
Results. Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months;
) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups;
). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (
) and the incidence of VAP was 18.3% versus 15% (
) in the chlorhexidine and the control group, respectively. There was no difference in intubation time (
), need for reintubation (
), time interval between hospitalization and nosocomial pneumonia diagnosis (
), time interval between surgery and nosocomial pneumonia diagnosis (
), and time on antibiotics (
) and vasoactive drugs (
) between groups. Median length of PICU stay (3 vs 4 days;
), median length of hospital stay (12 vs 11 days;
), and 28-day mortality (5.7% vs 6.8%;
) were also similar in the chlorhexidine and the control group.
Conclusions. Oral hygiene with 0.12% chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.
Trial registration. ClinicalTrials.gov identifier: NCT00829842.