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

NEW YORK (Reuters Health), Jun 9 - 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 versus 6.0 days) and mortality rates (34.8% versus 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 it 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.

Chest 2009;135:1150-1156.

Last Updated: 2009-06-08 8:00:29 -0400 (Reuters Health)

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.