The Effect of Chlorhexidine on Oral Bacterial Colonisation and Development of Nosocomial Infections in Life Threatened Patients

Abstract

Ciljevi: Zabilježiti u bolesnika na odjelu intenzivnog liječenja učinak dekontaminacije dentalnoga plaka i bukalne sluznice antiseptikom na kolonizaciju potencijalno patogenim nozokomijalnim bakterijama i razvoj nozokomijalnih infekcija. Vrsta: Dvostruko slijepa prospektivna poredbena studija zasnovana na nasumce odabranom uzorku. Mjesto: Odjel intenzivnoga liječenja s 12 kreveta u Kliničkoj bolnici “Dubrava”, Zagreb. Ispitanici: Bolesnici koji su jedan za drugim primljeni na odjel intenzivnog liječenja s bolešću koja je indicirala najmanje trodnevo liječenje. Bezubi su bolesnici isključeni iz studije. Terapije: Nakon nasumice izabranih bolesnika, provedena je terapija te skupine s 0,2% gelom klorheksidina, tri puta na dan za vrijeme njihova boravka na odjelu intenzivnog liječenja. Standardne mjere oralne higijene i placebo gel uporabljeni su na kontrolnoj skupini. Posebna mjerenja: Uzet je dentalni status s pomoću indeksa karijesa; količina plaka utvrđena je semikvantitativnim indeksom plaka. Uzeti su uzorci bakterija dentalnoga plaka, bukalne sluznice, nazalnog i trahealnog aspirata i krvi nultog dana, zatim trećeg, šestog i dalje svaka tri dana do otpusta bolesnika s odjela intenzivnog liječenja. Rezultati: Sudjelovalo je 60 bolesnika - 30 koji su primali terapiju i 30 iz kontrolne skupine (prosjek godina: 54,5±18,2, prosječna simplificirana akutna fiziološka vrijednost II (Simplified Acute Physiological Score II): 29±13,5 bodova). Pri prijmu u bolnicu nije bilo znatnih razlika između dviju skupina što se tiče kliničkih i dentalnih podataka. Srednja vrijednost indeksa karijesa iznosila je 19,5±5,5, a plak indeksa 1,7±0,62. Na dan prijma u 63% su bolesnika iz područja dentalnoga plaka i bukalne sluznice izolirane potencijalno patogene nozokomijalne bakterije. U usporedbi s kontrolnom skupinom iznos transkolonizacije bakterija u područje bronha znatno je smanjen (19/7 bolesnika, p=0,002), kao i incidencija razvoja nozokomijalne infekcije (26,7%/6,7%, p=0,041). Ti su rezultati bili konzistentni sa znatnim preventivnim učinkom antiseptičke dekontaminacije s 75% razmjernoga smanjenja rizika. Postojao je trend smanjenja vrijednosti plak indeksa, kolonizacije potencijalno patogenim bakterijama i duljine boravka na odjelu intenzivnoga liječenja.. Zaključci: Dekontaminacija dentalnoga plaka i bukalne sluznice antiseptikom, 0,2% gelom klorheksidina smanjuje oralnu bakterijsku kolonizaciju te može smanjiti incidenciju razvoja nozokomijalnih infekcija u životno ugroženih bolesnika.Aims: To record the effect of decontamination of dental plaque and buccal mucous membrane by antiseptics on the colonisation of potential pathogenic nosocomial bacteria and development of nosocomial infections in patients in the Department of Intensive Care. Type: A double blind prospective comparative study based on a randomly selected sample. Location: Department of Intensive Care with 12 beds in the University Hospital Dubrava. Subjects: Patients admitted one after the other in the Department of Intensive Care with a disease which indicated at least three days of treatment. Edentulous patients were excluded from the study. Therapy: After randomly selecting the patients, the group was treated with 0.2% gel chlorhexidine, three times daily for the duration of their stay in the Department. Standard measures of oral hygiene and placebo gel were applied in a control group. Specific measurements: Dental status was taken by means of caries index; the amount of plaque was determined by means of semi quantitative plaque index. Samples of bacteria were taken of dental plaque, buccal mucous membrane, nasal and tracheal aspirate and blood on the first, third and sixth day and thereafter every three days until the patient\u27s release from the Department of Intensive Treatment. Results: Sixty patients participated in the study: 30 who received therapy and 30 in a control group (mean age: 54.5±5.5 years, Simplified Acute Physiological Score II: 29±13.5 points). On admittance to hospital there were no significant differences between the two groups with regard to clinical and dental data. Average value of the caries index amounted to 19.5±5.5, and plaque index 1.7±0.62. On the day of admittance potentially pathogenic nosocomial bacteria were isolated from the area of dental plaque and buccal mucous membrane in 63% of patients. In relation to the control group the amount of transcolonisation of bacteria in the region of the bronchi was significantly reduced (19/7 patients, p=0.002), as also was the incidence of the development of nosocomial infections (26.7%/6.7%, p=0.041). These results were consistent with the significant preventive effect of antiseptic decontamination with 75% relatively reduced risk. There was a trend toward a decrease in the values of plaque index, colonisation of potential pathogenic bacteria and the duration of stay in the Department of Intensive Care. Conclusions: Decontamination of dental plaque and buccal mucous membrane by antiseptics, 0.2% gel chlorhexidine, reduced oral bacterial colonisation, and can reduce the incidence of the development of nosocomial infections in life threatened patients