Oral decontamination for prevention of ventilator-associated pneumonia in mechanically ventilated adults

Abstract

Overview of the Topic: Ventilator-associated pneumonia (VAP) is a healthcare associated infection found in mechanically ventilated patients, machines whose need increased due to the SARS-CoV-2 virus. This dissertation reviewed evidence on the effectiveness of oral decontamination with chlorhexidine gluconate (CHG) in reducing VAP in mechanically ventilated adults in comparison to non-antiseptic agents. The Research Question: In mechanically ventilated adults, does oral care with CHG antiseptic agent reduce VAP when compared to non-antiseptic agents; water-based placebo and 0.9% normal saline solution? PICO Elements: The intervention, oral care with CHG antiseptic agent in the population of mechanically ventilated patients, was compared to oral care with non antiseptic agents. The primary outcome was a reduction in VAP. Method: Different search terms were combined with search tools like Boolean Operators, with limiters applied to create a specific search strategy for each database or platform used. HyDi, EBSCO and PubMed were used, whose studies were screened, and had their eligibility assessed through the PRISMA framework and inclusion and exclusion criteria. The CASP tool was used to critically appraise the literature. Results: Six studies were identified, all based on a randomised control trial design. Three of the six studies found CHG to be beneficial in reducing VAP, while three found no statistically significant difference. Thus, the evidence available to date was deemed as inconclusive. Conclusion: When ranking the studies, the evidence points towards a beneficial effect of CHG oral decontamination in reducing VAP, however, further research is recommended to answer the PICO question. Implications and Recommendations: Conducting studies with higher quality, if possible multi-centred; aimed at having larger sample sizes and extended follow-up periods. More research must be carried out to answer the PICO question. Local research needs to be carried out to obtain local statistics regarding VAP in Malta. Finally, the oral decontamination should be monitored through ITU audits and adhered to for VAP reduction