The Effectiveness of Chlorhexidine in the Prevention of Pneumonia

It has been repeatedly stated that oral care is important in the prevention of ventilator-associated pneumonia (VAP). Endotracheal intubation predisposes patients to developing VAP. The tube acts as a conduit from the mouth to the lungs – a perfect track for bacteria to descend upon. Khezeri, et al. (2014) suggest that “the presence of an endotracheal tube (ETT) inhibits normal coughing, normal swallowing, and the protection of the trachea contact by epiglottis closure.” In addition, an endotracheal tube keeps the patients mouth open – leading to dryness. Bacteria are not washed away by saliva. Also, Landgraf, et al. (2017) mention that the presence of an endotracheal tube in the mouth causes “changes in the oral epithelium” which “might indicate risk for infection in intensive care patients

In clinical experience, it is seen that many patients in the Intensive Care Unit (ICU) are on mechanical ventilation. These patients range from having head trauma, heart surgery and respiratory problems yet there is no clear, concise systematic standard oral care procedures noted on the different floors in the hospital. Oral care is a basic nursing care activity that can provide relief, comfort and prevention of microbial growth yet is given low priority when compared to other critical practices in critically ill patients. The Center for Disease Control reveals that Ventilator-Associated Pneumonia (VAP) is the second most common nosocomial infection that affects approximately 27% of critically ill patients (Koeman, Van der Ven & Hak,

Oral care aims to supply an adequate hygiene level, which leads to reduce colonisation of dental plaque and oropharynx and to reduce the aspiration of contaminated secretions into the lower airway (Feider et al. 2010). Research has demonstrated that colonisation of the airway and aspiration of colonised saliva are the two main pathogenic causes of VAP (Adib-Hajbaghery et al. 2011). Other cause is the production of a biofilm along the endotracheal tube (ETT) which contains large quantities of microbes that could be spread into the lungs by ventilator-induced breaths (Keyt et al. 2014; Palomar et al. 2010). Additionally, instilling saline into the ETT, suctioning secretions, repositioning the ETT or coughing, could dislodge the biofilm into the airway and increase the risk of VAP (Moore. 2003; Morehead and Pinto. 2002).

To encourage physicians, ICU nurses, and respiratory therapist to use the ventilator associated pneumonia bundle in all ventilated patients in an intensive care unit.

This paper explores Pneumonia and the respiratory disease process associated with bacterial and viral pathogens most commonly located in the lung. The paper examines the process, symptoms and treatments most commonly viewed in patient cases of Pneumonia. My goal is to educate the reader and to warn of the

Ventilator-associated pneumonia is a bacterial infection that occurs in the lower respiratory system within the first 48 hours of endotrachal intubation (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011). Although any hospital patient is susceptible to pneumonia, ventilator dependent patients are at the highest risk of acquiring pneumonia. The purpose of this paper is to identify the risk factors, incidences, and preventions of ventilator-associated pneumonia (VAP) using a quantitative research study performed in Malaysia. “The aim of this

The authors of Current Opinion in Pulmonary Medicine state that “Ventilator-associated pneumonia (VAP), a subset of HAP that occurs in mechanically ventilated patients more than 48 h after tracheal intubation” The type of ventilator that is needed to treat patients is called a mechanical ventilator. For these ventilators, a tube has to be inserted down the person’s throat thus causing more bacterial to get inside the patient’s body. Conclusion While most may think that hospitals are an environment for patients to return to their healthy state, hospitals can also be an environment where it deters them from healing. Hospital-acquired illnesses kill many each year and is due to reason of neglect or misuse of equipment.

(2012) evaluated whether oral care by swabbing with 0.2% CHX decreases the risk of ventilator-associated pneumonia (VAP) in hospitalized patients. Patients 18 years and older were included in the study if they had no episode of chemical pneumonitis and have never been diagnosed with thrombocytopenia. Eligible patients were randomly assigned to one of two groups as follows: a CHX group (n=29) and a control group (n=32). Oral care was performed by swabbing oral mucosa with either CHX or saline on sponge pellets, four times daily (at 6 AM, 12 AM, 6 PM and 12 PM). Approximately 30 mL of 0.2% CHX or saline was applied and this lasted for about 1 minute. The control group received the standard oral care (saline applications). All patients were followed for at least 14 days or until discharge from the hospital, extubation or death. The main outcome in this study was the incidence of VAP and was assessed using a mouth mirror together with a headlight. VAP was observed in 34/61 patients (55.7%) within 6.8 days. The rate of the development of VAP was significantly higher in the control group (68.8%) compared to the CHX group (41.4%) [p = 0.03] with a significant odds ratio of 3.12 (95% CI = 1.09-8.91). This study identified acinetobacter baumannii (64.7%) as the most frequent pathogen of all study

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

Pneumonia is an inflammation of the lung which results into an excess of fluid or pus accumulating into the alveoli of the lung. Pneumonia impairs gas exchange which leads to hypoxemia and is acquire by inhaling a contagious organism or an irritating agent. (Ignatavicius & Workman, 2013). Fungal, bacteria and viruses are the most common organisms that can be inhale. Pneumonia could be community-acquired or health care associated. Community –acquired pneumonia (CAP) occurs out of a healthcare facility while health care associated pneumonia (HAP) is acquired in a healthcare facility. HAP are more resistant to antibiotic and patients on ventilators and those receiving kidney dialysis have a higher risk factor. Infants, children and the elderly also have a higher risk of acquiring pneumonia due to their immune system inability to fight the virus. Pneumonia can also be classified as aspiration pneumonia if it arises by inhaling saliva, vomit, food or drink into the lungs. Patients with abnormal gag reflex, dysphagia, brain injury, and are abusing drug or alcohol have a higher risk of aspiration pneumonia (Mayo Clinic, 2013). In the case of patient E.O., this patient had rhonchi in the lower lobe and the upper lobe sound was coarse and diminished. Signs and symptoms of pneumonia include difficulty breathing, chest pain, wheezing, fever, headache, chills, cough, confusion, pain in muscle or

I am writing to change the policy for chlorohexidine bathing among catheterized patients. I believe we need to end the role of chlorhexidine within the hospital setting and refer back to the soap and water technique.

According to studies from both developed and limited-resource countries, the most important clinical consequences due to VAP have increased death rates, significant disease, increased the length of stay, and additional health care costs. Although hospitals in limited-resource countries do implement infection control programs, agreement with infection control practices is inconsistent. A multicenter, potential, before-after observation study was conducted using International Nosocomial Infection Control Consortium Surveillance Online System. (V.D. Rosenthal et al/American Journal of Infection Control

The appropriateness of using respiratory care as a remedy for curing pneumonia can be challenged by the efficiency

Maintaining oral hygiene is a vital element of preventing hospital acquired pneumonia (HAP), many facilities do not have a specific policy in regards to oral care, if policies are in place, and practices are usually inconsistent. For patients that are intubated, endotracheal tube placement delivers a straight pathway for bacteria to enter the body. Ventilator-associated pneumonia (VAP) is a serious danger to patients who are on mechanical ventilation. Oral care is a nursing intervention that reduces the incidence of HAP and VAP. Oral care practices and policies vary from hospital to hospital, and may be inconsistent and difficult for nurses to follow. It is essential that nurses, certified nursing assistants, or patient care technicians

Chlorhexidine digluconate has been used for more than 50 years and considered as gold standard of antiseptic treatment since this agent is one of the most extensively used and tested (Giannelli et al., 2008). Despite the advantages of chlorhexidine, has disadvantages such as stains on teeth and tongue, desquamation lesions of a mucosa membrane of an oral cavity, breaks irritation, taste changes, tooth staining, moreover will induce a dose dependent reduction in cellular proliferation and that concentrations of chlorhexidine that have little effect on cellular proliferation can significantly reduce both collagen