Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-31T23:46:02.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of Oral Hygiene with 0.12% Chlorhexidine Gluconate on the Incidence of Nosocomial Pneumonia in Children Undergoing Cardiac Surgery

Published online by Cambridge University Press:  02 January 2015

Andréa D. N. Jácomo ,
Fabio Carmona ,
Alessandra K. Matsuno ,
Paulo H. Manso  and
Ana P. C. P. Carlotti
Andréa D. N. Jácomo
Affiliation:
Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Fabio Carmona
Affiliation:
Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Alessandra K. Matsuno
Affiliation:
Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Paulo H. Manso
Affiliation:
Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
Ana P. C. P. Carlotti*
Affiliation:
Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
*
Department of Pediatrics, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, 14049-900 Ribeirão Preto, São Paulo, Brazil ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the effect of oral hygiene with 0.12% Chlorhexidine gluconate on the incidence of nosocomial pneumonia and ventilator-associated pneumonia (VAP) in children undergoing cardiac surgery.

Design.

Prospective, randomized, double-blind, placebo-controlled trial.

Setting.

Pediatric intensive care unit (PICU) at a tertiary care hospital.

Patients.

One hundred sixty children undergoing surgery for congenital heart disease, randomized into 2 groups: Chlorhexidine (n = 87) and control (n = 73).

Interventions.

Oral hygiene with 0.12% Chlorhexidine gluconate or placebo preoperatively and twice a day postoperatively until PICU discharge or death.

Results.

Patients in experimental and control groups had similar ages (median, 12.2 vs 10.8 months; P = .72) and risk adjustment for congenital heart surgery 1 score distribution (66% in category 1 or 2 in both groups; P = .17). The incidence of nosocomial pneumonia was 29.8% versus 24.6% (P = .46) and the incidence of VAP was 18.3% versus 15% (P = .57) in the Chlorhexidine and the control group, respectively. There was no difference in intubation time (P = .34), need for reintubation (P = .37), time interval between hospitalization and nosocomial pneumonia diagnosis (P = .63), time interval between surgery and nosocomial pneumonia diagnosis (P = .10), and time on antibiotics (P = .77) and vasoactive drugs (P = .16) between groups. Median length of PICU stay (3 vs 4 days; P = .53), median length of hospital stay (12 vs 11 days; P = .67), and 28-day mortality (5.7% vs 6.8%; P = .77) were also similar in the Chlorhexidine and the control group.

Conclusions.

Oral hygiene with 0.12% Chlorhexidine gluconate did not reduce the incidence of nosocomial pneumonia and VAP in children undergoing cardiac surgery.

Trial Registration.

ClinicalTrials.gov identifier: NCT00829842.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 6 , June 2011 , pp. 591 - 596
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Grisaru-Soen, G, Paret, G, Yahav, D, Boyko, V, Lerner-Geva, L. Nosocomial infections in pediatric cardiovascular surgery patients: a 4-year survey. Pediatr Crit Care Med 2009;10:202–206.CrossRefGoogle ScholarPubMed
2.Pollock, E, Ford-Jones, LE, Rebeyka, I, et al.Early nosocomial infections in pediatric cardiovascular surgery patients. Crit Care Med 1990;18:378–383.CrossRefGoogle ScholarPubMed
3.Levy, I, Ovadia, B, Erez, E, et al.Nosocomial infections after cardiac surgery in infants and children: incidence and risk factors. J Hosp Infect 2003;53:111–116.CrossRefGoogle ScholarPubMed
4.Abramczyk, ML, Carvalho, WB, Carvalho, ES, Medeiros, EAS. Nosocomial infection in a pediatric intensive care unit in a developing country. Braz J Infect Dis 2003;7:375–380.CrossRefGoogle Scholar
5.Srinivasan, R, Asselin, J, Gildengorin, G, Wiener-Kronish, J, Fiori, HR. A prospective study of ventilator-associated pneumonia in children. Pediatrics 2009;123:1108–1115.CrossRefGoogle ScholarPubMed
6.Bigham, MT, Amato, R, Bondurrant, P, et al.Ventilator-associated pneumonia in the pediatrie intensive care unit: characterizing the problem and implementing a sustainable solution. J Pediatr 2009;154:582–587.CrossRefGoogle Scholar
7.Stockwell, JA. Nosocomial infections in the pediatric intensive care unit: affecting the impact on safety and outcome. Pediatr Crit Care Med 2007;8(suppl):S21–S37.CrossRefGoogle ScholarPubMed
8.Safdar, N, Crnich, CJ, Maki, DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care 2005;50:725–739.Google ScholarPubMed
9.De Riso, AJ, Ladowski, JS, Dillon, TA, Justice, JW, Peterson, AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109:1556–1561.CrossRefGoogle ScholarPubMed
10.Houston, S, Hougland, P, Anderson, JJ, LaRocco, M, Kennedy, V, Gent, LO. Effectiveness of 0.12% Chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care 2002;11:567–570.CrossRefGoogle ScholarPubMed
11.Segers, P, Speekenbrink, RGH, Ubbink, DT, van Ogtrop, ML, de Mol, BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with Chlorhexidine gluconate: a randomized controlled trial. JAMA 2006;296:2460–2466.CrossRefGoogle ScholarPubMed
12.Matsuno, AK, Carlotti, APCP, Mussi-Pinhata, MM. Nosocomial infection surveillance in Brazilian pediatric intensive care units. Pediatr Crit Care Med 2007;8:A75–A76.Google Scholar
13.Urbaniak, GC, Pious, S. Research Randomizer, http://www.randomizer.org/.Google Scholar
14.Marx, CM, Smith, PG, Lowrie, LH, et al.Optimal sedation of mechanically ventilated pediatric critical care patients. Crit Care Med 1994;22:163–170.CrossRefGoogle ScholarPubMed
15.Langley, JM, Bradley, JS. Defining pneumonia in critically ill infants and children. Pediatr Crit Care Med 2005;6(suppl):S9–S13.CrossRefGoogle ScholarPubMed
16.Schindler, MB, Cox, PN. A simple method of bronchoalveolar lavage. Anaesth Intens Care 1994;22:66–68.CrossRefGoogle ScholarPubMed
17.Leteurtre, S, Martinot, A, Duhamel, A, et al.Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003;362:192–197.CrossRefGoogle ScholarPubMed
18.Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004;7:180–184.CrossRefGoogle ScholarPubMed
19.Pollack, MM, Ruttimann, UE, Getson, PR. Pediatric risk of mortality (PRISM) score. Crit Care Med 1988;16:1110–1116.CrossRefGoogle ScholarPubMed
20.Sreenivasan, PK, Gittins, E. Effects of low dose Chlorhexidine mouthrinses on oral bacteria and salivary microflora including those producing hydrogen sulfide. Oral Microbiol Immunol 2004;19:309–313.CrossRefGoogle ScholarPubMed
21.Emilson, CG. Susceptibility of various microorganisms to Chlorhexidine. Scand J Dent Res 1977;85:255–265.Google ScholarPubMed
22.Foglia, E, Meier, MD, Elward, A. Ventilator-associated pneumonia in neonatal and pediatric intensive care unit patients. Clin Microbiol Rev 2007;20:409–425.CrossRefGoogle ScholarPubMed
23.Block, C, Furman, M. Association between intensity of Chlorhexidine use and microorganisms of reduced susceptibility in a hospital environment. J Hosp Infect 2002;51:201–206.CrossRefGoogle Scholar
24.Bellissimo-Rodrigues, F, Bellissimo-Rodrigues, WT, Viana, JM, et al.Effectiveness of oral rinse with Chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients. Infect Control Hosp Epidemiol 2009;30:952–958.CrossRefGoogle ScholarPubMed
25.Fourrier, F, Dubois, D, Pronnier, P, et al.Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 2005;33:1728–1735.CrossRefGoogle ScholarPubMed
26.Panchabhai, TS, Dangayach, NS, Krishnan, A, Kothari, VM, Kar-nad, DR. Oropharyngeal cleansing with 0.2% Chlorhexidine for prevention of nosocomial pneumonia in critically ill patients: an open-label randomized trial with 0.01% potassium permanganate as control. Chest 2009;135:1150–1156.CrossRefGoogle ScholarPubMed
27.Koeman, M, van de Ven, AJAM, Hak, E, et al.Oral decontamination with Chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006;173:1348–1355.CrossRefGoogle ScholarPubMed