title: Impact of chlorhexidine mouthwash prophylaxis on probable ventilator-associated pneumonia in a surgical intensive care unit.
abstract: BACKGROUND
  Prevention of ventilator-associated pneumonia is a healthcare goal. Although data is inconsistent, some studies suggest that oral chlorhexidine may decrease rates of pneumonia in mechanically-ventilated patients. We sought to assess the rate of pneumonia in the Surgical Intensive Care Unit (SICU) pre and post implementation of routine chlorhexidine mouthwash prophylaxis.
  
  
  METHODS
  A retrospective cohort study was conducted, including patients between 1/1/2009 and 12/31/2009 who did not receive chlorhexidine mouthwash compared to patients that received prophylactic chlorhexidine mouthwash between 3/1/2010 and 2/28/2011. The primary outcome of the study was rate of probable ventilator-associated pneumonia (VAP) for the pre-chlorhexidine implementation cohort compared to post-implementation, using the 2013 Center for Disease Control definitions. Mechanically ventilated patients with respiratory cultures were screened for inclusion in the study. Secondary endpoints included duration of mechanical ventilation, in-hospital mortality, ICU and hospital length of stay. Statistical analysis was conducted by Fisher's exact test for nominal data and Mann-Whitney U test for continuous data.
  
  
  RESULTS
  A total of 1780 mechanically ventilated patients in the pre-chlorhexidine group and 1854 in the post-chlorhexidine group were screened for inclusion. Of the 601 mechanically ventilated patients that were further evaluated for inclusion; 158 patients (26.3%) had positive cultures and were included in the study (94 pre-group and 64 post-group). The rate of probable VAP was significantly decreased in the post-group compared to the pre-group (1.85% pre vs 0.81% post, P = 0.0082).
  
  
  CONCLUSIONS
  Use of chlorhexidine mouthwash prophylaxis may reduce rates of probable VAP. Further study is warranted.
authors.affiliation: Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Emmanuel N
authors.initials: EN
authors.lastname: Enwere
authors.affiliation: Department of Pharmacy, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Elofson
authors.affiliation: Department of Surgery, Division of Kidney and Pancreas Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Forbes
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
keywords: Chlorhexidine; ICU; prevention; ventilator-associated pneumonia