1. Chlorhexidine Reduces Ventilator-Associated Pneumonia
Stacy A. Jacobs, Mount St. Joseph University, MAGELIN Program
In critically ill patients on mechanical
ventilators, how does the use of oral
chlorhexidine solution compared to
standard oral care (without chlorhexidine)
affect the incidence of ventilator-acquired
pneumonia?
PICO QUESTION
IMPLEMENTATION
• 3 systematic, meta-analysis articles (Level 1
Evidence)
• 4 randomized control trial articles (Level 2
Evidence)
PROBLEM 1. Unfreeze: Physicians, nurses, patients, and
families will be educated on the importance
of preventing pneumonia. Barriers of
implementation: nurses resist adding this to
their daily responsibilities, and physicians or
hospital administrators question the benefit
of chlorhexidine vs. the cost of supplies.
2. Moving Toward Change: The main focus
of implementing change will be the
education of nurses on how to properly
swab the mouth and tubing. Nurses and
physicians will also be educated on how to
teach patients and families why this new
standard of evidence based care is used.
3. Refreeze: There should be ongoing support
and education for this prevention method.
New nurses will be trained and expected to
incorporate their plan of care for ventilated
patients.
Nearly half of critically ill patients require
mechanical ventilation, which requires
patients to be intubated, and therefore,
their blockade between the oropharynx
and trachea is compromised. Many patients
on ventilators acquire pneumonia, and it
only takes as little as 48 hours for it to
develop. For these clients, pneumonia is
one of the major causes of morbidity and
mortality, with reported deaths ranging
between 24% and 50%. Ventilator-acquired
pneumonia (VAP) occurs from the
aspiration of bacteria from the mouth, from
leakage of bacterial secretions from the
endotracheal tube, and sometimes from
aspiration of stomach contents into the
lungs.
EVIDENCE
PROPOSED CHANGE
• Patients on mechanical ventilators receive
oral chlorhexidine cleanings at a 0.12%+
concentration every 4 hours.
• Support training and education for medical
personnel
SYSTEMATIC REVIEW
• Several studies found that chlorhexidine
application was shown to be effective in
reducing the occurrence of VAP at the p = 0.03,
p = 0.02, or p < 0.00001 level.
• Nine studies illustrated that 0.12%
chlorhexidine had a significant effect (p <
0.00001).
• Three studies also demonstrated that 2%
chlorhexidine significantly prevented VAP (p =
0.002).
• In patients with pneumonia upon admission,
one study found that chlorhexidine produced a
significant treatment effect from admission to
48 hours (p= 0.02) and to 72 hours (p = 0.027). References Available Upon Request