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Proper oral hygiene may cut risk of pneumonia in critically ill patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – New research shows that oropharyngeal cleansing with chlorhexidine solution is no better than a control solution of potassium permanganate in preventing nosocomial pneumonia in critically ill patients. However, the regular maintenance of “meticulous” oral hygiene does provide a benefit, the findings suggest.

There is clear evidence that oral cleansing with chlorhexidine can help stave off nosocomial pneumonia after heart surgery, Dr. Dilip R. Karnad, from Seth GS Medical College, Mumbai, and colleagues note. By contrast, the benefit of this intervention in critically ill patients is unclear.

The current study, reported in the May issue of Chest, featured 512 patients who were randomized to receive twice-daily oropharyngeal cleansing with 0.2% chlorhexidine or with the control solution.

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: 5.0 days. Likewise, the chlorhexidine and control groups had similar median ICU stays (5.0 vs. 6.0 days) and mortality rates (34.8% vs. 28.3%).

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 3 months before and following the study was 21.7% (p < 0.001; RR = 0.34).

“Meticulous oral cleansing seems to decrease the risk of the development of pneumonia regardless of the content of the solution used for this purpose,” the authors write.

“More studies using a higher concentration of chlorhexidine are required to establish the role of routine antiseptic oral cleansing in ICU patients,” they add.

Reference:
Chest 2009;135:1150-1156.