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Chlorhexidine Gluconate Use in Ventilator Assisted Patients Prevent Ventilator Associated Pneumonia
Ventilator associated pneumonia is a common and fatal complicated issue for patients in ventilator care within the intensive care unit. Ventilated and incubated patients are a challenging threat for registered nurses to deliver high quality of care. It has been observed that incubation impedes the natural defense of the body against respiratory infections. The placement of an endotracheal tube enforces negative effect on the cough reflexes, which aims to protect the airway from invasive pathogens. The endotracheal tube prevents mucocoliary clearance of secretions and depresses epiglottic reflexes (Rello, Lode, Cornaglia, & Masterton, 2010; Labeau, Vyver, Brusselaers, Vogelaers, & Blot, 2009). It causes the virulent bacteria to enter and it leaks around the inflated cuff of the endotracheal tube. Consequently, the lungs of patient infiltrate due to which pneumonia is caused. The ventilator associated pneumonia possibly occurs early or late during the course of intubation along with a mechanical ventilation of a patient (Evans, et al., 2011; Tantipong, Morkchareonpong, Jaiyindee, & Thamlikitkul, 2008; Abad, McKinley, & Safdar, 2008). The ventilator associated pneumonia is generally referred to nosocomial bacterial pneumonia, which develops in patients on ventilation. It is known to occur between 48 and 72 hours after tracheal intubation resulting from aspiration that has complicated the intubation procedure. If ventilator associated pneumonia occurs after this period, it is then known as late-onset pneumonia. The early onset pneumonia occurs due to the antibiotic sensitive bacteria, whereas, late onset pneumonia associated with ventilator patients is caused by antibiotic resistant pathogens. This disease consists of supportive care along with the administration of antibiotics and the mortality attributable to it is greater than ten percent (Pileggi, Bianco, Flotta, Nobile, & Pavia, 2011; Ozcaka, et al., 2012).
The PICO question regarding the paper is "Does the use of chlorhexidine gluconate use in ventilator assisted patients prevent ventilator associated pneumonia?"
The search strategy for this research paper is the use of keywords including chlorhexidine + ventilator associated pneumonia, intensive care unit + ventilator associated pneumonia, infection control + ventilator associated pneumonia, and mechanical ventilation + chlorhexidine gluconate. These keywords are used on Google, Medline, ProQuest, and EbscoHost.
Ventilator Associated Pneumonia
According to the studies of Evans, et al. (2011), Lorente, Blot, and Rello (2007), and Shi, et al. (2010), nosocomial infections are responsible for approximately forty to ninety deaths costing more than $20 billion in the United States. It is found in the studies of Abad, McKinley, and Safdar (2008), and Evans, et al. (2011) that ventilator associated pneumonia is the most common nosocomial infection among the patients in the intensive care unit. Maselli and Restrepo (2011), Tantipong, Morkchareonpong, Jaiyindee, and Thamlikitkul (2008), and Lorente, Blot, and Rello (2007) conducted the study in a hospital in Tehran and the results provide the evidence of pneumonia to be the most common infection among the patients of Tehran.The reports of its neighboring countries also presented that pneumonia is found to be most prevalent infection in the intensive care unit as Lebanon reported approximately 45% and India reported approximately 80%. It can be said that ventilator associated pneumonia occurs in at least 20% patients receiving mechanical ventilation and it is responsible for the occurrence of nosocomial infections in patients on ventilators (Pileggi, Bianco, Flotta, Nobile, & Pavia, 2011; Chan, Ruest, Meade, & Cook, 2007; Elward, Warren, & Fraser, 2002).
The colonization of respiratory-gastrointestinal system and aspiration of contaminated secretions are observed to be introduced as most important processes playing their role in the development of the ventilator associated pneumonia. Panchabhai and Dangayach (2009) provide that the negative species can be replaced in throat within two days after hospitalization but it has been observed that the patients in ventilation are exposed to the contact with bacteria in the environment of ICUs. Safdar, Crnich, and Maki (2005), on the contrary, have provided the significant role of tracheal tube in colonization of bronchial tracheal tree while making the patients prone to aspiration has caused the need for endotracheal tube is inevitable in different patients. Tantipong, Morkchareonpong, Jaiyindee, and Thamlikitkul (2008) have proposed that use of non-absorbable antibiotic for selective cleaning of the gastrointestinal tract is a way of reducing the incidence of nosocomial infection. It has been found that this method increases the chances of developing of resistant species. The chlorhexidine glucomate is known to be the bisbiguanide disinfectant and it is effective on different types of bacteria, viruses, and fungi (Lorente, Blot, & Rello, 2007; Shorr & Kollef, 2005; Chan, Ruest, Meade, & Cook, 2007; Tantipong, Morkchareonpong, Jaiyindee, & Thamlikitkul, 2008). The study of Ozcaka, et al. (2012) do not reflect the reduced incidence of pneumonia, duration of hospital stay, and mortality among patients receiving ventilation. The results of the study show that the reduction of pneumonia incidence in patients as they are exposed to the higher risk of ventilator associated pneumonia. On the other hand, the results of Chastre and Fagon (2002) do not show the reduced incidence of pneumonia in the ventilator associated patients. It is known that ventilator associated pneumonia is caused by stronger pathogens due to which it has high mortality rates. The direct impact of intervention on the ventilator associated pneumonia has been considered in most studies (Lorente, Blot, & Rello, 2007; Chastre & Fagon, 2002; Abad, McKinley, & Safdar, 2008; Rello, Lode, Cornaglia, & Masterton, 2010). The higher intensity of disease as a risk factor is being considered in many studies, but its interaction with interventions are not much mentioned (Maselli & Restrepo, 2011; Safdar, Crnich, & Maki, 2005; Tantipong, Morkchareonpong, Jaiyindee, & Thamlikitkul, 2008). The studies of Labeau, Vyver, Brusselaers, Vogelaers, and Blot (2009), and Hutchins, Karras, Erwin, and Sullivan (2009) have performed the efficacy of cleaning the gastrointestinal tract with antibiotics to prevent ventilator associated pneumonia but it is complicated to reduce the risk of drug addiction in patients. It has been found that such type of risk is not evident in the chlorhexidine glucomate.
An extensive literature search of clinical trials regarding ventilator associated patients prevention with the use of chlorhexidine glucomate in oral care was taken under consideration in this paper. It has been observed that the study of Chan, Ruest, Meade, and Cook (2007) highlight the side effects related to 2% chlorhexidine glucomate were observed in the patients and the side effects were reported as mild, reversible, and influencing the oral mucosa. A meta-analysis of Kola and Gastmeier (2007) shows the result for a chlorhexidine glucomate that it may provide a reduction of ventilator associated in patients with high risk of pneumonia. The results of Shorr and Wunderink (2003) show that chlorhexidine glucomate 0.12% and chlorhexidine glucomate 0.2% were used in the majority of trials and no effect in reduction of ventilator associated pneumonia. However, a study of Shorr and Kollef (2005) shows the low incidence of ventilator associated pneumonia but these findings were consistent with the meta analysis of Abad, McKinley, and Safdar (2008). It can be argued that the trials of Tantipong, Morkchareonpong, Jaiyindee, and Thamlikitkul (2008) performed in the ventilator associated pneumonia and achieved the effect from the use of chlorhexidine glucomate. === reported that the use of chlorhexidine glucomate for the ventilator associated pneumonia is found to e the cost effective along with the safe alternative as compared to the cost of treating the disease with the use of prophylactic antibiotic therapy. Elward, Warren, and Fraser (2002), and Safdar, Dezfulian, Collard, and Saint (2005) the meta analysis provides that the side effects in the individual trials of patients going through the ventilator associated pneumonia are minimized and it is proved that the use of chlorhexidine glucomate can prove as the safe alternative to the prophylactic antibiotics.
The studies included in the research paper have contributed in its completeness and it is concluded that the chlorhexidine glucomate is proved to be beneficial in the prevention of ventilator associated pneumonia. The paper has provided that almost 2% of chlorhexidine glucomate is more effective as compared to any other strategy for the patients receiving mechanical ventilation (Elward, Warren, & Fraser, 2002; Labeau, Vyver, Brusselaers, Vogelaers, & Blot, 2009). There is no evidence of the reduction in the mortality due to the use of chlorhexidine glucomate has been found in the studies. It can be recommended that rigorous studies should be conducted while considering the administration procedures and cost effectiveness of chlorhexidine glucomate. Different studies in the paper have provided that analysis of the patients suffering from the ventilator associated pneumonia are provided with different preventive medications among which chlorhexidine glucomate is very common (Labeau, Vyver, Brusselaers, Vogelaers, & Blot, 2009; Tantipong, Morkchareonpong, Jaiyindee, & Thamlikitkul, 2008; Ozcaka, et al., 2012). It can be said that the use of cholorohexidine glucomate is effective in terms of its use, side effects, and cost. The side effects of the chlorohexidine glucomate are far less as compared to other preventive strategies due to their side effects that cause addiction to the patients for their entire…[continue]
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