Oral mucosal decontamination with chlorhexidine for the prevention of ventilator-associated pneumonia in children-A randomized, controlled trial

Pediatric Critical Care Medicine

Volumn 13, Issue 5, 2012, Pages

  Sebastian, Meghna Raju ^a   Lodha, Rakesh ^a   Kapil, Arti ^a   Kabra, Sushil K ^a  

^a ALL INDIA INSTITUTE OF MEDICAL SCIENCES   (India)

Author keywords

chlorhexidine; oral mucosal decontamination; ventilator associated pneumonia

Indexed keywords

CHLORHEXIDINE; PLACEBO;

ABSENCE OF SIDE EFFECTS; ACINETOBACTER; ADOLESCENT; ARTICLE; ARTIFICIAL VENTILATION; ASEPSIS; CHEEK MUCOSA; CHILD; CLINICAL ARTICLE; CONTROLLED STUDY; DOUBLE BLIND PROCEDURE; ENDOTRACHEAL INTUBATION; FEMALE; HOSPITALIZATION; HUMAN; INFANT; INTENSIVE CARE; LENGTH OF STAY; MALE; MORTALITY; NASOTRACHEAL INTUBATION; PRESCHOOL CHILD; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; SCHOOL CHILD; TERTIARY HEALTH CARE; TREATMENT DURATION; VENTILATOR ASSOCIATED PNEUMONIA;

ACINETOBACTER; ACINETOBACTER INFECTIONS; ADMINISTRATION, TOPICAL; ADOLESCENT; ANTI-INFECTIVE AGENTS, LOCAL; CHILD; CHILD, PRESCHOOL; CHLORHEXIDINE; DECONTAMINATION; DOUBLE-BLIND METHOD; FEMALE; HUMANS; INFANT; INTENSIVE CARE UNITS, PEDIATRIC; LENGTH OF STAY; MALE; MOUTH MUCOSA; PNEUMONIA, VENTILATOR-ASSOCIATED; RESPIRATION, ARTIFICIAL;

EID: 84866370810     PISSN: 15297535     EISSN: 19473893     Source Type: Journal    
DOI: 10.1097/PCC.0b013e31824ea119     Document Type: Article

References (35)

1. Edwards JR, Peterson KD, Andrus ML, et al: National Healthcare Safety Network Facilities: National Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued November 2008. Am J Infect Control 2008; 36:609-626
2. Patra PK, Jayashree M, Singhi S, et al: Noso-comial pneumonia in a pediatric intensive care unit. Indian Pediatr 2007; 44:511-518
3. Sharma H, Singh D, Pooni P, et al: A study of profle of ventilator-associated pneumonia in children in Punjab. J Trop Pediatr 2009; 55:393-395
4. Bigham MT, Amato R, Bondurrant P, et al: Ventilator-associated pneumonia in the pedi-atric intensive care unit: Characterizing the problem and implementing a sustainable solution. J Pediatr 2009; 154:582-587.e2
5. Gibbons RJ: Bacterial adhesion to oral tissue: A model for infectious disease. J Dent Res 1989; 68:750-760
6. Whittaker CJ, Klier CM, Kolenbrander PE: Mechanisms of adhesion by oral bacteria. Annu Rev Microbiol 1996; 50:513-552
7. Scannapieco PK, Busch R, Paju S: Associations between periodontal disease and risk for nosocomial bacterial pneumonia and chronic obstructive pulmonary disease. Ann Peri-odontol 2003; 8:54-69
8. Coffn SE, Klompas M, Classen D, et al: Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008; 29(Suppl 1):S31-S40
9. Chlebicki MP, Safdar N: Topical chlorhexidine for prevention of ventilator-associated pneumonia: A meta-analysis. Crit Care Med 2007; 35:595-602
10. Grap MJ, Munro CL, Hamilton VA, et al: Early, single chlorhexidine application reduces ventilator-associated pneumonia in trauma patients. Heart Lung 2011; 40:e115-e122
11. MacNaughton P, Bailey J, Donlin N, et al: A randomized controlled trial assessing effcacy of oral chlorhexidine in ventilated patients. Intensive Care Med 2004; 30(Suppl 1):S5-S18
12. Fourrier F, Dubois D, Pronnier P, et al: PIRAD Study Group: Effect of gingival and dental plaque antiseptic decontamination on nosoco-mial infections acquired in the intensive care unit: A double-blind placebo-controlled multicenter study. Crit Care Med 2005; 33:1728-1735
13. Panchabhai TS, Dangayach NS, Krishnan A, et al: Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: An open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009; 135:1150-1156
14. Houston S, Hougland P, Anderson JJ, et al: Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002; 11:567-570
15. DeRiso AJ 2nd, Ladowski JS, Dillon TA, et al: Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996; 109:1556-1561
16. Segers P, Speekenbrink RG, Ubbink DT, et al: Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with chlorhexidine glu-conate: A randomized controlled trial. JAMA 2006; 296:2460-2466
17. Panchabhai TS, Dangayad NS, Krishnan A, et al: Oropharyngeal cleansing with 0.2% chlorhexidine for prevention of nosocomial pneumonia in critically ill patients. An open-label randomized control trial with 0.01% potassium permanganate as control. Chest 2009; 135:1150-1156
18. Koeman M, van der Ven AJ, Hak E, et al: Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006; 173:1348-1355
19. Tantipong H, Morkchareonpong C, Jaiyindee S, et al: Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2008; 29:131-136
20. de la Rosa M, Sturzenberger O P, Moore DJ: The use of chlorhexidine in the management of gingivitis in children. J Periodontol 1988; 59:387-389
21. Lindén LA, Björkman S, Hattab F: The diffusion in vitro of fuoride and chlorhexidine in the enamel of human deciduous and permanent teeth. Arch Oral Biol 1986; 31:33-37
22. Fourrier F, Cau-Pottier E, Boutigny H, et al: Effects of dental plaque antiseptic decontamination on bacterial colonization and noso-comial infections in critically ill patients. Intensive Care Med 2000; 26:1239-1247
23. Thukral A, Lodha R, Irshad M, et al: Performance of Pediatric Risk of Mortality (PRISM), Pediatric Index of Mortality (PIM), and PIM2 in a pediatric intensive care unit in a developing country. Pediatr Crit Care Med 2006; 7:356-361
24. Slater Shann F, Pearson G: PIM2: A revised version of the Paediatric Index of Mortality. Intensive Care Med 2003; 29:278-285
25. Garner JS, Jarvis WR, Emori TG, et al: CDC defnitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128-140
26. Meduri GU, Beals DH, Maijub AG, et al: Protected bronchoalveolar lavage. A new bronchoscopic technique to retrieve uncon-taminated distal airway secretions. Am Rev Respir Dis 1991; 143(4 Pt 1):855-864
27. Campbell GDJr: Blinded invasive diagnostic procedures in ventilator-associated pneumonia. Chest 2000; 117(4 Suppl 2):207S-211S
28. Russell AD, Day MJ: Antibacterial activity of chlorhexidine. J Hosp Infect 1993; 25:229-238
29. Emilson CG: Susceptibility of various microorganisms to chlorhexidine. Scand J Dent Res 1977; 85:255-265
30. Hammond SA, Morgan JR, Russell AD: Comparative susceptibility of hospital isolates of gram-negative bacteria to antiseptics and disinfectants. J Hosp Infect 1987; 9:255-264
31. Scannapieco FA, Yu J, Raghavendran K, et al: A randomized trial of chlorhexidine gluco-nate on oral bacterial pathogens in mechanically ventilated patients. Crit Care 2009; 13:R117
32. Davies GE, Francis J, Martin AR, et al: 1:6-Di-4'- chlorophenyldiguanidohexane (hibitane); Laboratory investigation of a new antibacterial agent of high potency. Br J Pharmacol Chemother 1954; 9:192-196
33. Oosterwaal PJ, Mikx FH, van den Brink ME, et al: Bactericidal concentrations of chlorhex-idine-digluconate, amine fuoride gel and stannous fuoride gel for subgingival bacteria tested in serum at short contact times. J Peri-odont Res 1989; 24:155-160
34. Jácomo AD, Carmona F, Matsuno AK, et al: Effect of oral hygiene with 0.12% chlorhexi-dine gluconate on the incidence of nosoco-mial pneumonia in children undergoing cardiac surgery. Infect Control Hosp Epidemiol 2011; 32:591-596
35. Trouillet JL, Chastre J, Vuagnat A, et al: Ventilator-associated pneumonia caused by potentially drug-resistant bacteria. Am J Respir Crit Care Med 1998; 157:531-539