title: The effect of chlorhexidine in reducing oral colonisation in geriatric patients: a randomised controlled trial.
abstract: BACKGROUND
  Inadequate oral care has been implicated in the development of aspiration pneumonia in frail geriatric patients and is a major cause of mortality, due to the colonisation of microbes in vulnerable patients. This type of pneumonia has been associated with an increase in respiratory pathogens in the oral cavity. The aim of this study was to evaluate the effects of chlorhexidine compared to routine oral care in edentulous geriatric inpatients.
  
  
  METHODS
  A double-blind, parallel-group randomised controlled trial was carried out. The intervention group received oral care with chlorhexidine 0.2%, while the control group received routine oral care with thymol. Nurses provided oral care with assigned solutions of 20 mL once daily over seven days. Oral cavity assessment using the Brief Oral Health Status Examination form was performed before each oral care procedure. Data on medication received and the subsequent development of aspiration pneumonia was recorded. An oral swab was performed on Day 7 to obtain specimens to test for colonisation.
  
  
  RESULTS
  The final sample consisted of 35 (control) and 43 (intervention) patients. Chlorhexidine was effective in reducing oral colonisation compared to routine oral care with thymol (p < 0.001). The risk of oral bacterial colonisation was nearly three times higher in the thymol group compared to the chlorhexidine group.
  
  
  CONCLUSIONS
  The use of chlorhexidine 0.2% significantly reduced oral colonisation and is recommended as an easier and more cost-effective alternative for oral hygiene.
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Department of Nursing, Faculty of Health Science, Universiti Teknologi MARA, Puncak Alam Campus, Selangor, Malaysia.
authors.forename: Sharifah Shafinaz Binti
authors.initials: SS
authors.lastname: Sharif-Abdullah
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Mei Chan
authors.initials: MC
authors.lastname: Chong
authors.affiliation: Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Surat Singh
authors.initials: SS
authors.lastname: Surindar-Kaur
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shahrul Bahyah
authors.initials: SB
authors.lastname: Kamaruzzaman
authors.affiliation: Department of Biomedical Imaging & University of Malaya Research Imaging Centre, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Kwan Hoong
authors.initials: KH
authors.lastname: Ng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005853:Geriatrics / Q000379:methods; D006801:Humans; D008297:Male; D009066:Mouth, Edentulous / Q000628:therapy; D009910:Oral Hygiene; D011015:Pneumonia, Aspiration / Q000382:microbiology / Q000517:prevention & control*; D053717:Pneumonia, Ventilator-Associated; D012107:Research Design; D012137:Respiratory System / Q000382:microbiology; D013943:Thymol / Q000627:therapeutic use
chemical_list: D000891:Anti-Infective Agents, Local; D013943:Thymol; D002710:Chlorhexidine
keywords: aspiration; chlorhexidine; geriatrics; oral; pneumonia