Assessing Use of Chlorhexidine in Prevention of VAP

¶ … oral chlorhexidine as preventative agent in of ventilator-associated pneumonia (VAP) in adults who are critically ill and mechanically ventilated in intensive care units (ICUs). The process of critiquing published studies leads to higher level of comprehension of empirical and evidence-based research. The discussion devotes some consideration to the way the authors addressed the protection of human participants, the research methodology -- including data collection, data management and analysis -- the research findings, and the conclusions drawn from the study outcomes.

Protection of Human Participants

Risks to human participants in this research were minimal since the study is retrospective review of research. The original research studies protected the identity of the research participants, and data was presented in the aggregate form. The current research article is yet another layer away from the original studies and further still from the original information about the participants, none of which was presented in disaggregate form or with pertinent identifying features.

Data Collection

The research studies included in the review were randomized controlled trials (RCTs) published in English, and that used comparative groups to investigate the effect of oral chlorhexidine as a decontaminant in VAP prevention in participants meeting the selection criteria vs. A placebo. The dependent variable in the selected studies was a reduction in the incidence of VAP in mechanically ventilated adult ICU patients with the use of chlorhexidine. The review also sought data about the reduction of mortality. The independent variables were primarily the inclusion criteria of participants in the studies review, which was determined by the need for mechanical ventilation, being admitted to an ICU, age 18 years or older, and being critically ill. When data was missing from a study, the authors attempted to contact the investigators to obtain data that would add weight to the research or when the study outcomes were insufficiently reported. An extensive review of the literature was undertaken for the time period between June 2010 and June 2011.

Data Management and Analysis

Since the article was a review of extant research, it was important to assess the heterogeneity of the data. To accomplish this, pooled effect sizes of risk ratio (RR) of were estimated using the random effects model (Mantel-Haenszel) and confidence intervals of 95% of dichotomous data were presented. The random effects model accounts for the percentage of variability in the estimates of effects that is due to heterogeneity instead of chance. A statistical software package (Review Manager, v.5.1., Cochrane Collection) was used for the data analysis. Additionally, subgroup analysis was used on completed trial data once the clinical diversity due to different concentrations of chlorhexidine was identified. Conducting a pilot and using a standardized data extraction form ensured rigor in reliability, validity, and quality treatment and assessment of the collected research data. Full texts of relevant articles that met the inclusion criteria were reviewed and analyzed for methodological quality by two researchers who conducted the reviews independently, with a third reviewer identified and available for consultation if disagreements could not be resolved by discussion.

Findings / Interpretation of Findings: Implications for Practice & Future Research

The researchers concluded that chlorhexidine was beneficial in the prevention of VAP, and that the probability of mechanically ventilated patients acquiring VAP when using chlorhexidine was 36% less likely than for the controls. A 2% level of chlorhexidine was most effective, but the number of studies that used that particular level of chlorhexidine was few, which was a limitation of the research review and one the authors suggest should be followed up in future research. However, the research did not show a reduction in mortality. The veracity of the research findings was consistent with previous research by Chalebick and Safsar, in which a pooled RR of 0.70 was found (95% CI 0.48 -104; p=0.08). The presentation of the findings was logical and organized, an imperative, as there are many considerations about data when conducted a review of extant research. The findings are applicable to nurses working in critical care units and certainly underscore the importance of using chlorhexidine with ventilated patients.