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J Caring Sci. 2022;11(3): 178-187.
doi: 10.34172/jcs.2021.029
PMID: 36247039
PMCID: PMC9526792
Scopus ID: 85138064217
  Abstract View: 1078
  PDF Download: 621
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Systematic Review

Oropharyngeal Decontamination for Prevention of VAP in Patients Admitted to Intensive Care Units: A Systematic Review

Aliakbar Keykha 1 ORCID logo, Monir Ramezani 2,3 ORCID logo, Shahram Amini 4,5 ORCID logo, Hossein Karimi Moonaghi 1,2,6* ORCID logo

1 Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2 Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
4 Lung Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
5 Department of Anaesthesiology and Critical Care, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
6 Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
*Corresponding Author: Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Email KarimiH@mums.ac.ir
*Corresponding Author: Corresponding Author: Hossein Karimi Moonaghi, Email: , Email: KarimiH@mums.ac.ir

Abstract

Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oral hygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients. This study aimed to evaluate recent OHC strategies to decrease VAP.

Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases from inception to September 10, 2020 were reviewed to compare the effects of selective oropharyngeal decontamination (SOD) on the incidence of VAP in adult patients requiring mechanical ventilation.

Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for final analysis. The results showed that the use of chlorhexidine for oropharyngeal decontamination reduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria. Also, it was observed that the combined use of colistin and chlorhexidine was more effective than chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes to reduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time. However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine, Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, while Iseganan did not show a significant effect in this regard.

Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effective in reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics is more effective than other methods in oropharyngeal decontamination.

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Submitted: 16 Apr 2021
Revision: 17 Jun 2021
Accepted: 17 Jun 2021
ePublished: 07 Sep 2021
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