2.50
Hdl Handle:
http://hdl.handle.net/10755/157110
Category:
Abstract
Type:
Presentation
Title:
Early, Single Chlorhexidine Application to Reduce Oral Flora and VAP in Trauma Victims
Author(s):
Grap, Mary Jo; Munro, Cindy; Elswick, R.K.; Higgins, Stephanie; Sessler, Curtis; Ward, Kevin
Author Details:
Mary Jo Grap, Virginia Commonwealth University, Richmond, Virginia, USA, email: mjgrap@vcu.edu; Cindy Munro; R.K. Elswick; Stephanie Higgins; Curtis Sessler; Kevin Ward
Abstract:
PURPOSE: Ventilator-associated pneumonia (VAP) occurs most often in trauma, burn, and surgical patients. Reduction of oral bacteria associated with VAP reduces the pool of organisms available for translocation to the lung. VAP reduction occurs with repeated CHX dosing, but use of a single dose has not been studied. This randomized, controlled clinical trial tested an early (within 12 hours of intubation) application of chlorhexidine (CHX) by swab versus control (no swab), on oral microbial flora and VAP. BACKGROUND: VAP is responsible for 90% of nosocomial infections in the mechanically ventilated population. Growth of potentially pathogenic bacteria in dental plaque provides a nidus of infection for microorganisms that have been shown to be responsible for the development of VAP. Organisms associated with VAP colonize the oral pharynx of the critically ill patient prior to the VAP diagnosis. Reduction of organisms in the oral cavity using CHX immediately after intubation may reduce the incidence of VAP. METHODS: 145 trauma patients requiring endotracheal intubation were randomly assigned to either the intervention (5 mL CHX) or control group. Oral microbial flora from semi-quantitative oral cultures and VAP (clinical pulmonary infection score-CPIS) were obtained on study admission, at 24 (oral culture data only), 48 and 72 hours after intubation. Trauma-injury and severity score (TRISS), illness severity (APACHE III) and frequency of usual oral care were also recorded. A repeated measure proportional odds model tested for differences in the oral cultures between the groups and a repeated measures random effects model tested for differences in CPIS with CPIS greater than 6 indicating VAP. RESULTS: Of the 145 randomized patients, 71 and 74 were randomized to intervention and control, respectively. Patients were 70% male and 60% white. Mean age was 42.4 years (+/- 18.2); mean APACHE III score was 66 (+/- 29.8). There were no significant differences between groups at study admission for any clinical characteristic except higher CPIS scores (5.05 (+/- 0.28) for intervention vs. 3.98 (+/- 0.27) for control, p<0.01) and greater levels of positive oral cultures (18.3% intervention versus 5.6% control, p<0.01). No significant treatment effect (p=0.33) on oral cultures was found. However, a significant treatment effect (p=0.0233) on CPIS both from admission to 48 hrs and to 72 hrs was found. CONCLUSIONS: Since 41.7% of the control patients with a baseline CPIS less than 6 (no VAP) had developed VAP by 48 or 72 hours vs. only 19.4% of the intervention patients, this study showed that the use of a single dose of CHX early in the intubation period is effective in reducing early VAP especially in trauma patients without pneumonia at intubation. Very few positive oral cultures were observed in this study making it difficult to find changes in this outcome across time or between the groups.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleEarly, Single Chlorhexidine Application to Reduce Oral Flora and VAP in Trauma Victimsen_GB
dc.contributor.authorGrap, Mary Joen_GB
dc.contributor.authorMunro, Cindyen_GB
dc.contributor.authorElswick, R.K.en_GB
dc.contributor.authorHiggins, Stephanieen_GB
dc.contributor.authorSessler, Curtisen_GB
dc.contributor.authorWard, Kevinen_GB
dc.author.detailsMary Jo Grap, Virginia Commonwealth University, Richmond, Virginia, USA, email: mjgrap@vcu.edu; Cindy Munro; R.K. Elswick; Stephanie Higgins; Curtis Sessler; Kevin Warden_GB
dc.identifier.urihttp://hdl.handle.net/10755/157110-
dc.description.abstractPURPOSE: Ventilator-associated pneumonia (VAP) occurs most often in trauma, burn, and surgical patients. Reduction of oral bacteria associated with VAP reduces the pool of organisms available for translocation to the lung. VAP reduction occurs with repeated CHX dosing, but use of a single dose has not been studied. This randomized, controlled clinical trial tested an early (within 12 hours of intubation) application of chlorhexidine (CHX) by swab versus control (no swab), on oral microbial flora and VAP. BACKGROUND: VAP is responsible for 90% of nosocomial infections in the mechanically ventilated population. Growth of potentially pathogenic bacteria in dental plaque provides a nidus of infection for microorganisms that have been shown to be responsible for the development of VAP. Organisms associated with VAP colonize the oral pharynx of the critically ill patient prior to the VAP diagnosis. Reduction of organisms in the oral cavity using CHX immediately after intubation may reduce the incidence of VAP. METHODS: 145 trauma patients requiring endotracheal intubation were randomly assigned to either the intervention (5 mL CHX) or control group. Oral microbial flora from semi-quantitative oral cultures and VAP (clinical pulmonary infection score-CPIS) were obtained on study admission, at 24 (oral culture data only), 48 and 72 hours after intubation. Trauma-injury and severity score (TRISS), illness severity (APACHE III) and frequency of usual oral care were also recorded. A repeated measure proportional odds model tested for differences in the oral cultures between the groups and a repeated measures random effects model tested for differences in CPIS with CPIS greater than 6 indicating VAP. RESULTS: Of the 145 randomized patients, 71 and 74 were randomized to intervention and control, respectively. Patients were 70% male and 60% white. Mean age was 42.4 years (+/- 18.2); mean APACHE III score was 66 (+/- 29.8). There were no significant differences between groups at study admission for any clinical characteristic except higher CPIS scores (5.05 (+/- 0.28) for intervention vs. 3.98 (+/- 0.27) for control, p<0.01) and greater levels of positive oral cultures (18.3% intervention versus 5.6% control, p<0.01). No significant treatment effect (p=0.33) on oral cultures was found. However, a significant treatment effect (p=0.0233) on CPIS both from admission to 48 hrs and to 72 hrs was found. CONCLUSIONS: Since 41.7% of the control patients with a baseline CPIS less than 6 (no VAP) had developed VAP by 48 or 72 hours vs. only 19.4% of the intervention patients, this study showed that the use of a single dose of CHX early in the intubation period is effective in reducing early VAP especially in trauma patients without pneumonia at intubation. Very few positive oral cultures were observed in this study making it difficult to find changes in this outcome across time or between the groups.en_GB
dc.date.available2011-10-26T19:25:48Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:25:48Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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