Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study

• Published in: Heart & lung Vol. 33; no. 2; pp. 83 - 91
• Main Authors: Grap, Mary Jo, Munro, Cindy L, Elswick, R.K, Sessler, Curtis N, Ward, Kevin R
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-03-2004
• Subjects: Adult; Aged; Aged, 80 and over; Chemoprevention; Chlorhexidine - administration & dosage; Chlorhexidine - analogs & derivatives; Chlorhexidine - pharmacology; Chlorhexidine - therapeutic use; Colony Count, Microbial; Cross Infection - prevention & control; Female; Haemophilus - drug effects; Haemophilus - isolation & purification; Humans; Intensive Care Units; Male; Middle Aged; Mouthwashes - administration & dosage; Mouthwashes - pharmacology; Mouthwashes - therapeutic use; Pilot Projects; Pneumonia - etiology; Pneumonia - prevention & control; Pseudomonas - drug effects; Pseudomonas - isolation & purification; Respiration, Artificial - adverse effects; Staphylococcus - drug effects; Staphylococcus - isolation & purification; Virginia; Virginia
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2003.12.004

The purpose of this study was to describe the effect of an early post-intubation oral application of chlorhexidine gluconate on oral microbial flora and ventilator-associated pneumonia.
Thirty-four intubated patients were randomly assigned to chlorhexidine gluconate by spray or swab or to control group. Oral cultures were done at study admission, 12, 24, 48, and 72 hours, whereas the Clinical Pulmonary Infection Score (CPIS) was documented at study admission, 48, and 72 hours.
Reductions in oral culture scores (less growth) were only found in the treatment groups (swab and spray); no reduction was found in the control group. There was a trend for fewer positive cultures in the combined treatment groups. The mean CPIS for the control group increased to a level indicating pneumonia (4.7 to 6.6), whereas the CPIS for the treatment group increased only slightly (5.17 to 5.57).
Trends in the data suggest that use of chlorhexidine gluconate in the early post-intubation period may mitigate or delay the development of ventilator-associated pneumonia.