Thesis (MCur)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Ventilator-Associated Pneumonia (VAP) is a hospital acquired infection, not present or
incubating at the time of admission and developing in patients during the process of care within
the hospital setting. Between nine and twenty-seven percent of patients who are mechanically
ventilated will develop ventilator-associated pneumonia. Mortality rates for ventilated patients
who develop ventilator-associated pneumonia are estimated to be between 33-50%. The Institute
for Healthcare Improvements (IHI) in 2006 recommended the use of ‘care bundles’ to reduce
VAP but no statistically significant decline has been noted.
Despite the completion of an extensive literature search for purposes of this review, no statistical
data on nosocomial infections or nosocomial pneumonia relevant to South Africa was found.
Mechanical ventilation, a support therapy used in approximately one third of patients,
significantly increases the patient’s risk of developing this nosocomial pneumonia. Critically ill
patients are by virtue of their critical illness more prone to the development of infections,
especially ventilator-associated pneumonia. Consistent evidence suggests that oropharyngeal
colonization can be associated with the development of VAP. Studies focusing on standard oral
care, with or without the concurrent use of chlorhexidine, have not provided sufficient evidence
for the use of chlorhexidine in VAP prevention. Chlorhexidine is an antiseptic agent, which
when tested, proved to reduce total respiratory tract infections by up to 69% (DeRiso et al,
1996:1558).
Objective: The aim of this study was to systematically appraise and review evidence on the
effectiveness of chlorhexidine in reducing the incidence of ventilator-associated pneumonia in
adult patients. The secondary aim was to systematically summarize evidence on the use of
chlorhexidine in reducing mortality.
Methodology: An extensive literature search of studies published in English was undertaken.
Electronic databases searched were CENTRAL, CINAHL, EMBASE and MEDLINE. Reference
lists of articles, textbooks and conference summaries were examined. Literature searches were conducted using Medical Subject Headings (MeSH). These included: Ventilator-associated
pneumonia, chlorhexidine, VAP and oral care. Eight randomized controlled trials, investigating
the efficacy of Chlorhexidine in ventilator-associated pneumonia prevention in adults met the
inclusion criteria. The effect measure of choice was Risk ratio with 95% confidence intervals for
dichotomous data using the random effects (Mantel-Haenszel) model; (p=value of 0.05).
Heterogeneity was assessed using the Cochrane Q statistic and I².
Results: Eight randomized controlled trials met the inclusion criteria for this review. Pooled risk
ratio for the incidence of ventilator-associated pneumonia was 0.64 (95% CI; 0.44-0.91; p
=0.18). Treatment with chlorhexidine decreased the risk of ventilator-associated pneumonia by
36%. There was no evidence of Chlorhexidine reducing mortality.
Conclusions: Chlorhexidine is a cost effective safe treatment in the prevention of VAP. The use
of 2% chlorhexidine may be more effective in reducing the incidence of VAP. No studies were
found conducted in developing countries. More rigorously designed trials using 2%
chlorhexidine are recommended. / AFRIKAANSE OPSOMMING: Agtergrond
Ventilator-Geassosieerde Longontsteking (VAP) is 'n hospitaal verkry infeksie, nie teenwoordig
met toelating nie. Ventilator-geassosieerde longontsteking word ontwikkel in pasiënte tydens die
proses van sorg in die hospitaal. Tussen nege en sewe en twintig persent van pasiënte wat
meganies geventileer word kry ventilator-geassosieerde pneumonie. Sterftesyfers vir
geventileerde pasiënte wat ventilator-geassosieerde pneumonie ontwikkel is na raming tussen 33-
50%. Die Institute for Healthcare Improvements (IHI) het in 2006 die gebruik van 'sorg bundels'
aanbeveel om VAP te verminder, maar geen statisties beduidende daling is aangeteken nie.
Ten spyte van 'n uitgebreide literatuur soek, is geen statistiese data op nosokomiale infeksies of
nosokomiale longontsteking toepaslik tot Suid-Afrika gevind nie. Meganiese ventilasie, 'n
ondersteuningsterapie wat gebruik word in ongeveer een derde van die pasiënte, verhoog
aansienlik die pasiënt se risiko vir die ontwikkeling van hierdie nosokomiale longontsteking.
Kritiek siek pasiënte is op gronde van hul kritieke toestand meer geneig tot die ontwikkeling van
infeksies, veral ventilator-geassosieerde pneumonie. Konsekwente bewyse dui daarop dat
orofaringeale kolonisasie kan met die ontwikkeling van VAP geassosieer word. Studies wat
fokus op standaard mond sorg, met of sonder die gelyktydige gebruik van chlorhexidine, het nie
voldoende bewyse vir die gebruik van chlorhexidine in VAP voorkoming nie. Chlorhexidine is 'n
antiseptiese agent, wat wanneer in een verewekansigde gekontroleerde studies (VGS) getoets
was die totale respiratoriese kanaal infeksies verminder deur tot 69%.
Doel: Die doel van hierdie sistematiese literatuuroorsig was om stelselmatig te evalueer en
bewyse oor die effektiwiteit van chlorhexidine in die vermindering en voorkoms van ventilatorgeassosieerde
pneumonie in volwasse pasiënte te hersien. Die sekondêre doel was om
stelselmatig bewyse op te som op die gebruik van chlorhexidine in die vermindering van sterfte.
Metodiek: 'n Uitgebreide literatuursoektog van studies wat in Engels gepubliseer is was
onderneem. CENTRAL, CINAHL, EMBASE en MEDLINE was deursoek. Naslaanlyste van
artikels, handboeke en konferensie opsommings is ondersoek. Die literatuur soektog is uitgevoer
met behulp van Medical Subject Headings (MeSH). Dit sluit in: ventilator-geassosieerde pneumonie, chlorhexidine, VAP en mond sorg. Agt verewekansigde gekontroleerde studies
(VGS), wat die doeltreffendheid van Chlorhexidine in ventilator-geassosieerde pneumonie
voorkoming in volwassenes ondersoek, was ingesluit vir hierdie studie. Die effek mate van keuse
was risiko ratio (RR) met 95% vertrouensintervalle met behulp van die ewekansige effekte
(Mantel-Haenszel) model; (p = 0.05). Heterogeniteit is bepaal deur gebruik te maak van die
Cochrane Q- statistiek en I².
Hoof resultate: Agt verewekansigde gekontroleerde studies (VGS) het die insluiting kriteria vir
hierdie oorsig gepas. Gepoelde risiko ratio vir die voorkoms van ventilator-geassosieerde
pneumonie: Risiko Ratio (RR) was 0.64 (95% CI; 0.44-0.91; p=0.18).
Gevolgtrekkings: Behandeling met chlorhexidine het die risiko van ventilator-geassosieerde
pneumonie met 36% gedaal. Daar was geen bewyse van Chlorhexidine op die vermindering van
mortaliteit nie. Chlorhexidine is 'n koste-effektiewe veilige behandeling in die voorkoming van
VAP. Die gebruik van 2% chlorhexidine kan moontlik meer effektief wees in die vermindering
van die voorkoms van VAP. Meer streng ontwerp studies met 2% chlorhexidine word aanbeveel.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/17943 |
| Date | 12 1900 |
| Creators | Snyders, Olivia Gayle |
| Contributors | Khondowe, Oswell, Bell, Janet, Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Nursing Science. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 65 p. |
| Rights | Stellenbosch University |
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