Effect of 0.12% Chlorhexidine Oral Rinse on Preventing Hospital-Acquired Pneumonia in Nonventilator Inpatients

10.1097/jnr.0000000000000527

Yen-Chin CHEN；En-Ni KU；Pei-Fang TSAI；Cheng-Man NG；Jiun-Ling WANG；Che-Wei LIN；Nai-Ying KO；Ying-Ju CHANG

oral rinse ； chlorhexidine ； nonventilator hospital-acquired pneumonia ； pneumonia-associated bacteria

The Journal of Nursing Research

30卷6期（2022 / 12 / 01）

1 - 9

英文

Background: Nonventilator hospital-associated pneumonia (NV-HAP) is a nosocomial infection with a multifactorial etiology that is particularly prevalent in individuals with poor oral health. Purpose: This study was designed to determine the effect of a 0.12% chlorhexidine gluconate oral rinse intervention on oral health and on reducing NV-HAP in inpatients. Methods: A randomized, double-blind, and triple-arm clinical trial was conducted on a sample of 103 patients aged ≥ 50 years. Using the blocking sample method, patients were randomly assigned into three groups. These included Group A, using an oral rinse solution of 0.12% chlorhexidine; Group B, using Listerine; and Group C, using a standard saline oral rinse. In addition to routine hospital-associated pneumonia preventative nursing care, the participants used the oral rinse solutions twice a day with a period of at least 9 hours between each use. Oral health, the degree of bacterial exposure, and the clinical pneumonia index scale were evaluated in each of the groups at baseline (first day), on Intervention Days 3 and 7, and at discharge. The clearance rate was calculated by dividing the number of bacteria cleared by the total frequency of oral bacteria in the collected culture 100%. Results: Each arm of the study was composed of 34-35 participants, with an average hospitalization duration of 7.5 days. There was no incidence of NV-HAP or any changes in clinical pulmonary infection score among the three groups. Group A achieved a more significant improvement in oral health assessment tool scores between baseline and discharge than either Group B or C (p = .03), particularly in the tongue, gums, and tissues; saliva; and oral cleanliness subscales. In addition, Group A reported higher clearance rates for Staphylococcus (100.00%vs. 66.67%vs. 66.67%, respectively), Escherichia coli (100.00% vs. 60.00% vs. 66.67%, respectively), and Pseudomonas aeruginosa (75.00% vs. 46.30% vs. 25.00%, respectively) than Groups B and C. Conclusions/Implications for Practice: Although the results do not provide evidence supporting the use of a 0.12% chlorhexidine oral rinse as better in terms of preventing NV-HAP in middle-aged and elderly inpatients, nursing supervision was found to have an overall positive effect on oral health. The use of oral rinse with 0.12% chlorhexidine for nonventilated patients with poor oral health may be recommended.

1. Alshehri, F. A.(2018).The use of mouthwash containing essential oils (LISTERINE®) to improve oral health: A systematic review.The Saudi Dental Journal,30(1),2-6.
2. Arnold, F. W.,Reyes Vega, A. M.,Salunkhe, V.,Furmanek, S.,Furman, C.,Morton, L.,Faul, A.,Yankeelov, P.,Ramirez, J. A.(2020).Older adults hospitalized for pneumonia in the United States: Incidence, epidemiology, and outcomes.Journal of the American Geriatrics Society,68(5),1007-1014.
3. Block, S. S.(2001).Disinfection, sterilization, and preservation.Lippincott Williams & Wilkins.
4. Brookes, Z. L. S.,Bescos, R.,Belfield, L. A.,Ali, K.,Roberts, A.(2020).Current uses of chlorhexidine for management of oral disease: A narrative review.Journal of Dentistry,103,Article 103497.
5. Carey, E.,Blankenhorn, R.,Chen, P.,Munro, S.(2022).Nonventilator associated hospital acquired pneumonia incidence and health outcomes among U.S. veterans from 2016–2020.American Journal of Infection Control,50(1),116-119.
6. Chalmers, J. M.,King, P. L.,Spencer, A. J.,Wright, F. A.,Carter, K. D.(2005).The oral health assessment tool—Validity and reliability.Australian Dental Journal,50(3),191-199.
7. Chou, C.-C.,Shen, C.-F.,Chen, S.-J.,Chen, H.-M.,Wang, Y.-C.,Chang, W.-S.,Chang, Y.-T.,Chen, W.-Y.,Huang, C.-Y.,Kuo, C.-C.,Li, M.-C.,Lin, J.-F.,Lin, S.-P.,Ting, S.-W.,Weng, T.-C.,Wu, P.-S.,Wu, U.-I.,Lin, P.-C.,Lee, S. S.-J.,Lin, M.-C.(2019).Recommendations and guidelines for the treatment of pneumonia in Taiwan.Journal of Microbiology, Immunology and Infection,52(1),172-199.
8. Deschepper, M.,Waegeman, W.,Eeckloo, K.,Vogelaers, D.,Blot, S.(2018).Effects of chlorhexidine gluconate oral care on hospital mortality: A hospital-wide, observational cohort study.Intensive Care Medine,44(7),1017-1026.
9. Ewan, V.,Hellyer, T.,Newton, J.,Simpson, J.(2017).New horizons in hospital acquired pneumonia in older people.Age and Ageing,46(3),352-358.
10. Giuliano, K. K.,Baker, D.,Quinn, B.(2018).The epidemiology of nonventilator hospital-acquired pneumonia in the United States.American Journal of Infection Control,46(3),322-327.
11. Hollaar, V. R. Y.,van der Putten, G.-J.,van der Maarel-Wierink, C. D.,Bronkhorst, E. M.,de Swart, B. J. M.,Creugers, N. H. J.(2017).The effect of a daily application of a 0.05% chlorhexidine oral rinse solution on the incidence of aspiration pneumonia in nursing home residents: A multicenter study.BMC Geriatrics,17(1),128.
12. James, P.,Worthington, H. V.,Parnell, C.,Harding, M.,Lamont, T.,Cheung, A.,Whelton, H.,Riley, P.(2017).Chlorhexidine mouthrinse as an adjunctive treatment for gingival health.Cochrane Database Systematic of Reviews,3(3),Article CD008676.
13. Kalyani, P.,Leelavathi, L.(2019).Comparison between the effect of plain water, herbal mouthwash, and chlorhexidine mouthwash on salivary pH.Drug Invention Today,11(5),1184-1187.
14. Kes, D.,Aydin Yildirim, T.,Kuru, C.,Pazarlıoglu, F.,Ciftci, T.,Ozdemir, M.(2021).Effect of 0.12% chlorhexidine use for oral care on ventilator-associated respiratory infections: A randomized controlled trial.Journal of Trauma Nursing,28(4),228-234.
15. Miletic, I.,Baraba, A.(2011).Aetiological factors for susceptibility: Saliva (roles, pH scoring) and bacteria.Journal of Minimum Intervention in Dentistry,4(2),17-19.
16. Mitchell, B. G.,Russo, P. L.,Cheng, A. C.,Stewardson, A. J.,Rosebrock, H.,Curtis, S. J.,Robinson, S.,Kiernan, M.(2019).Strategies to reduce non-ventilator-associated hospital-acquired pneumonia: A systematic review.Infection, Disease & Health,24(4),229-239.
17. Ogbac, M. K.,Arquiza, J.(2018).Effect of oral chlorhexidine in preventing hospital-acquired pneumonia among non-intubated patients in the Philippines.European Respiratory Journal,52(62, Suppl.),Article PA2641.
18. Palmer, L. B.,Albulak, K.,Fields, S.,Filkin, A. M.,Simon, S.,Smaldone, G. C.(2001).Oral clearance and pathogenic oropharyngeal colonization in the elderly.American Journal of Respiratory and Critical Care Medicine,164(3),464-468.
19. Pugin, J.(2002).Clinical signs and scores for the diagnosis of ventilator-associated pneumonia.Minerva Anestesiologica,68(4),261-265.
20. Rabello, F.,Araujo, V. E.,Magalhaes, S.(2018).Effectiveness of oral chlorhexidine for the prevention of nosocomial pneumonia and ventilator-associated pneumonia in intensive care units: Overview of systematic reviews.International Journal of Dental Hygiene,16(4),441-449.
21. Scannapieco, F. A.,Yu, J.,Raghavendran, K.,Vacanti, A.,Owens, S. I.,Wood, K.,Mylotte, J. M.(2009).A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients.Critical Care,13(4),R117.
22. Veitz-Keenan, A.,Ferraiolo, D. M.(2017).Oral care with chlorhexidine seems effective for reducing the incidence of ventilator-associated pneumonia.Evidence-Based Dentistry,18(4),113-114.