Proper Oral Hygiene Could Reduce Risk of Pneumonia in Critically Ill Patients

Regular maintenance of meticulous oral hygiene is effective in preventing nosocomial pneumonia in critically ill patients, according to a new study.

Researchers at Seth GS Medical College and the King Edward Memorial Hospital (Mumbai, India) conducted a study involving 512 patients admitted to the intensive care unit (ICU) who were randomized to receive twice-daily oropharyngeal cleansing with either a 0.2% chlorhexidine solution or with a 0.01% potassium permanganate (control) solution. The primary outcomes were effects on the incidence of nosocomial pneumonia during ICU stay. Secondary outcomes were length of stay in the ICU and in-hospital mortality.

The researchers found that the rate of nosocomial pneumonia during the ICU stay was 7.1% in the chlorhexidine group, not significantly lower than the 7.7% rate seen in the control group. The median day of development of pneumonia was identical in each group: five days. Likewise, the chlorhexidine and control groups had similar median ICU stays and mortality rates. Despite these null findings, oropharyngeal cleansing did seem to be beneficial; during the study, the nosocomial pneumonia rate was 7.4%, whereas the rate in the three months before and following the study it was 21.7%. The study was published in the May 2009 issue of Chest.

"Meticulous oral cleansing seems to decrease the risk of the development of pneumonia regardless of the content of the solution used for this purpose,” concluded lead author Dilip Karnad, M.D., and colleagues of the medical-neuro ICU. "More studies using a higher concentration of chlorhexidine are required to establish the role of routine antiseptic oral cleansing in ICU patients.”

Chlorhexidine is a chemical antiseptic that kills both gram-positive and gram-negative microbes, although it is less effective with some of the gram-negative microbes; it is also bacteriostatic. Oral cleansing with chlorhexidine following cardiac surgery has been found to decrease the incidence of nosocomial pneumonia; however, the benefit of this intervention in critically ill patients has not been positively demonstrated.

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Seth GS Medical College and the King Edward Memorial Hospital