title: Chlorhexidine decreases the risk of ventilator-associated pneumonia in intensive care unit patients: a randomized clinical trial.
abstract: OBJECTIVE
  The aim was to evaluate whether oral swabbing with 0.2% chlorhexidine gluconate (CHX) decreases the risk of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients.
  
  
  METHODS
  Sixty-one dentate patients scheduled for invasive mechanical ventilation for at least 48 h were included in this randomized, double-blind, controlled study. As these patients were variably incapacitated, oral care was provided by swabbing the oral mucosa four times/d with CHX in the CHX group (29 patients) and with saline in the control group (32 patients). Clinical periodontal measurements were recorded, and lower-respiratory-tract specimens were obtained for microbiological analysis on admission and when VAP was suspected. Pathogens were identified by quantifying colonies using standard culture techniques.
  
  
  RESULTS
  Ventilator-associated pneumonia developed in 34/61 patients (55.7%) within 6.8 d. The VAP development rate was significantly higher in the control group than in the CHX group (68.8% vs. 41.4%, respectively; p = 0.03) with an odds ratio of 3.12 (95% confidence interval = 1.09-8.91). Acinetobacter baumannii was the most common pathogen (64.7%) of all species identified. There were no significant differences between the two groups in clinical periodontal measurements, VAP development time, pathogens detected or mortality rate.
  
  
  CONCLUSIONS
  The finding of the present study, that oral care with CHX swabbing reduces the risk of VAP development in mechanically ventilated patients, strongly supports its use in ICUs and indeed the importance of adequate oral hygiene in preventing medical complications.
authors.affiliation: Department of Periodontology, School of Dentistry, Ege University, İzmir, Türkiye. ozgunozcaka@yahoo.com
authors.forename: Ö
authors.initials: Ö
authors.lastname: Özçaka
authors.forename: O K
authors.initials: OK
authors.lastname: Başoğlu
authors.forename: N
authors.initials: N
authors.lastname: Buduneli
authors.forename: M S
authors.initials: MS
authors.lastname: Taşbakan
authors.forename: F
authors.initials: F
authors.lastname: Bacakoğlu
authors.forename: D F
authors.initials: DF
authors.lastname: Kinane
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000302:isolation & purification; D000287:Administration, Topical; D000367:Age Factors; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D018893:Bronchoalveolar Lavage / Q000379:methods; D002710:Chlorhexidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003422:Critical Care; D003774:Dental Plaque Index; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000382:microbiology; D008875:Middle Aged; D009910:Oral Hygiene; D010512:Periodontal Index; D053717:Pneumonia, Ventilator-Associated / Q000382:microbiology / Q000517:prevention & control*; D012121:Respiration, Artificial; D012307:Risk Factors; D013396:Suction / Q000379:methods
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine