Effect of Chlorhexidine gluconate oral rinse on preventing of late onset ventilator associated pneumonia and it's interaction with severity of illness

The respiratory-digestive mechanism colonization and aspiration of contaminated secretions to the lower respiratory tract are two main processes in creating pneumonia associating with artificial ventilation. This study was conducted to determine the effect of chlorhexidine gluconate 0.2% oral rinse in preventing from pneumonia associated with delayed artificial ventilation and its interactive effect with disease severity. In this clinical trial study, 80 patients newly admitted in the general intensive care unit (ICU) of Loqman-e-Hakim hospital were selected randomly and assigned in two groups. Patients of experimental and control groups received daily twice chlorhexidine oral rinse and normal saline oral rinse, respectively. Ventilator associated pneumonia was diagnosed by Modified Clinical Pulmonary Infection Score (MCPIS). The overall incidence of late VAP was 16.25% (5 VS 25% in experimental and control groups, respectively). Fisher’s exact test showed a significant differences between two groups (p<0.05). Average score of illness severity in chlorhexidine group was 26.41 while in normal saline group was 23.95 that implied a significant statistical difference (p<0.001). Patients with higher severity of illness didn’t develop VAP in chlorhexidine group. Selective decontamination or cleaning of digestive tract with chlorhexidine oral rinse twice a day does not differ from normal saline in prevention of ventilator associated pneumonia, but can reduce the late onset of ventilator associated pneumonia and is effective in patients with more severe condition.