title: Duration of action of a single, early oral application of chlorhexidine on oral microbial flora in mechanically ventilated patients: a pilot study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Adult Health Department of the School of Nursing, Virginia Commonwealth University, Richmond 23298-0567, USA.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Grap
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Munro
authors.forename: R K
authors.initials: RK
authors.lastname: Elswick
authors.forename: Curtis N
authors.initials: CN
authors.lastname: Sessler
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018890:Chemoprevention; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006190:Haemophilus / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D010865:Pilot Projects; D011014:Pneumonia / Q000209:etiology / Q000517:prevention & control*; D011549:Pseudomonas / Q000187:drug effects / Q000302:isolation & purification; D012121:Respiration, Artificial / Q000009:adverse effects*; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification; D014768:Virginia
chemical_list: D009067:Mouthwashes; C010882:chlorhexidine gluconate; D002710:Chlorhexidine