A comparison of different types of oral antiseptic in the prevention of ventilator-associated pneumonia

Abstract

Overview of the topic: In the intensive care unit (ICU) patients who are intubated or undergoing artificial ventilation are at risk of developing Ventilator-associated pneumonia (VAP). VAP occurs when the endotracheal tube, which delivers oxygen to the lungs, acts as a vehicle for pathogenic bacteria that spreads from the oral cavity to the lungs. Recent evidence has shown that chlorhexidine (CHX), which is a broad-spectrum antiseptic, may help minimize bacterial overgrowth and the risk of VAP infection. Thus, the use of CHX in the ICU will benefit from further investigation to ensure its efficacy. Aim: The aim of this study was to compare the effectiveness of chlorhexidine mouthwash to other types of oral antiseptics on mechanically ventilated adult patients. Research question: In mechanically ventilated adult patients, how does the use of chlorhexidine mouthwash compared with other types of oral antiseptics reduce the risk of ventilator-associated pneumonia? PICO elements: Population (P): Mechanically ventilated adult patients. Intervention (I): Chlorhexidine mouthwash. Comparison (C): other types of oral antiseptics. Outcome (O): reduced risk of ventilator-associated pneumonia. Methods of appraisal used: Several electronic databases were used to conduct a comprehensive and systematic literature review. There was also a manual search. Studies reported in full text, written in English, and based on mechanically ventilated patients were included in this study. Six randomised control trials were identified, and the CASP tool was used to objectively evaluate them. Ethical considerations were taken into account. Results and Conclusion: Even though CHX is the gold standard in oral care, the results of the six studies examined did not support its use as strongly as previously thought. CHX was found to be effective in reducing the risk of VAP in two studies by Azimi et al. (2016) and Khezri et al. (2013). Other studies showed that, despite having the highest concentration of CHX, this was insufficient to minimize the incidence of pneumonia in mechanically ventilated patients. Additionally, CHX did not eliminate VAP but rather delayed its onset. In view of this, more research is required to determine the best prevention method for VAP. Implications and Recommendations: Further research is needed, especially that aimed at reducing limitations and confounding variables, as well as bridging the literature's numerous gaps. To obtain more generalizable results, more research can involve both local and international studies, as well as patients from different intensive care facilities. Additionally, raise awareness among student nurses and nurses through credible research, lectures, and the development of care pathways, protocols, and guidelines.