title: Effects of hydrogen peroxide mouthwash on preventing ventilator-associated pneumonia in patients admitted to the intensive care unit.
abstract: OBJECTIVE
  The aim of the study was to determine the effect of hydrogen peroxide (HP) mouthwash on the incidence of ventilator associated pneumonia (VAP) in patients admitted to the intensive care unit (ICU).
  
  
  METHODS
  This was a randomized clinical trial conducted on 68 patients. The intervention group used 3% HP as mouthwash and the control group used mouthwashes with 0.9% normal saline (NS) twice a day. Data were collected using a questionnaire and the Modified Clinical Pulmonary Infection Score (MCPIS). MCPIS includes five items, body temperature: white blood cell count, pulmonary secretions, the ratio of pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2), and the chest X-ray. Each of these items scored 0-2. Scores ≥6 were considered as VAP signs. The SPSS-20 software was employed to analyze the data.
  
  
  RESULTS
  In total, 14.7% patients of the HP group and 38.2% patients of the NS group contracted VAP. The risk of VAP in the NS group was 2.60 times greater than that in the HP group (RR=2.60, 95% CI: 1.04-6.49, p=0.0279). The mean±SD MCPIS was calculated as 3.91±1.35 in the HP group and 4.65±1.55 in the NS group, a difference statistically significant (p=0.042). There were no significant differences in the risk factors for VAP between the two groups.
  
  
  CONCLUSIONS
  HP mouthwash was found more effective than NS in reducing VAP. HP mouthwash can therefore be used in routine nursing care for reducing VAP.
authors.affiliation: Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran; Department of Nursing, Faculty of Nursing and Allied Health, Semnan University of Medical Sciences, Semnan, Iran. Electronic address: Nobahar43@Semums.ac.ir.
authors.forename: Monir
authors.initials: M
authors.lastname: Nobahar
authors.affiliation: Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Razavi
authors.affiliation: Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Farhad
authors.initials: F
authors.lastname: Malek
authors.affiliation: Research Center for Social Determinants of Health and Research Center of Physiology, Department of Community Medicine, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran.
authors.forename: Raheb
authors.initials: R
authors.lastname: Ghorbani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006861:Hydrogen Peroxide / Q000627:therapeutic use*; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes / Q000627:therapeutic use*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D015203:Reproducibility of Results; D012307:Risk Factors; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000382:microbiology
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D006861:Hydrogen Peroxide
keywords: Hydrogen peroxide; Intensive care unit; Nosocomial infection; Ventilator associated pneumonia