Comparing chlorhexidine mouthwash with different mouthwash practices in preventing VAP

Abstract

The aim of this dissertation was to appraise critically literature pertaining to the effectiveness of chlorhexidine in comparison with other mouthwash practices in preventing VAP. A research question was formulated using the PICO framework, namely, ‘Is chlorhexidine mouthwash more effective than other oral care practices in enhancing basic oral care to prevent ventilator-associated pneumonia in critically-ill patients?’ The population studied included mechanically-ventilated, critically-ill patients. Intervention and comparison were chlorhexidine mouthwash and other oral care practices respectively, while the desired outcome was prevention of ventilator-associated pneumonia (VAP). Following the selection of five (5) databases, a thorough search was conducted. Inclusion criteria consisted mainly of studies whose participants were mechanically-ventilated, critically- ill adult patients aged eighteen (18) years or older, studies preventing VAP, human studies, studies comprising meta-analysis, systematic reviews, and randomised controlled trials (RCTs) which were available in full text and written in English, as well as studies published from the year 2000 onwards. Studies failing to meet such criteria were not selected for this dissertation. After the elimination of irrelevant and/or duplicate studies, seven (7) articles remained. The selected key articles comprised one (1) systematic review and six (6) RCTs. The NICE algorithm and CASP checklist were the two main tools utilised to appraise the chosen articles. The selected studies incorporated a number of different outcomes, categorised either as primary or secondary outcomes. Primary outcomes included prevention of VAP, course duration for the development of VAP and/or the quantity of respiratory pathogens colonised in the oral cavity and/or lower respiratory tract. On the other hand, secondary outcomes included clinical pulmonary infection score (CPIS), antibiotic use, number of hospital ICU and ventilator days, possible side effects of chlorhexidine, cost-effectiveness and mortality rates. It was concluded that applying 2% chlorhexidine solution numerous times daily is not only more effective than lower concentrations of chlorhexidine, namely, 0.12% and 0.2%, but also more effective than other oral practices in preventing VAP. Gaps in literature were further identified. Recommendations included the requisite for further research including local studies and increased awareness amongst health care professionals (HCPs) through educational means.