EFFECT OF ORAL HYGIENE AND 0.12% CHLORHEXIDINE GLUCONATE ORAL RINSE IN PREVENTING OF VENTILATOR-ASSOCIATED PNEUMONIA AFTER CARDIOVASCULAR SURGERY

Ventilator-associated pneumonia is a nosocomial
infection of multifactorial etiology and has a negative influence on
cardiovascular surgery outcomes.

OBJECTIVES::

To
determine the effect of tooth-brushing plus 0.12% chlorhexidine
gluconate oral rinse in preventing of ventilator-associated pneumonia
after cardiovascular surgery.

METHODS::

In a
quasi-experimental study patients undergoing heart surgery were enrolled
on a protocol for controlling dental biofilm by proper oral hygiene
(tooth brushing) and oral rinses with 0.12% chlorhexidine gluconate
(Group 1), and were compared to a group of historical controls (Group
2), which included patients who underwent cardiac surgery between 2009
and 2010 and who received regular oral hygiene care. Seventy-two hours
before surgery, a dentist instructed and supervised oral hygiene with
tooth brushing and chlorhexidine oral rinses in patients in Group 1.

RESULTS::

Each
group comprised 150 patients. A lower incidence of ventilatorassociated
pneumonia (2.66%; 95% CI = 0.71-7.8 vs. 8.66%; 95% CI= 4.88- 14.66;
p=0.04), and shorter hospital stay (measured in days) (9 ± 3; 95% CI =
8.51-9.48 vs. 10 ± 4; 95% CI= 9.35-10.64; p=0.01) were observed in Group
1. No significant differences in all-cause in-hospital death were
observed between groups (5.33% vs. 4.66%; p=1.00). The risk for
developing pneumonia after surgery was three-fold higher in Group 2 (OR
3.87; 95% CI =1.05-14.19).

CONCLUSIONS::

Oral hygiene and
mouth rinses with chlorhexidine under supervision of a dentist proved
effective in reducing the incidence of ventilator-associated pneumonia.