Oral care and oropharyngeal and tracheal colonization by Gram-negative pathogens in children

• Published in: Nursing in critical care 2012-05, Vol.17 (3), p.115-122
• Main Authors: Kusahara, Denise Miyuki, Friedlander, Lais Tambelli, Peterlini, Maria Angélica Sorgini, Pedreira, Mavilde Luz Gonçalves
• Format: Article
• Language: English
• Subjects: Administration, Oral; Age; Anti-Infective Agents, Local - administration & dosage; Antiseptics; Brazil; Child; Child, Preschool; Children; Chlorhexidine; Chlorhexidine - administration & dosage; Colonization; Data processing; Demography; Double-Blind Method; Female; Gram-Negative Bacteria - growth & development; Gram-Negative Bacteria - pathogenicity; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - drug therapy; Hospitals; Humans; Immunoglobulins; Infant; Infection control; Intensive care; Intensive care units; Intensive Care Units, Pediatric; Length of Stay; Male; Microbial Sensitivity Tests; Microorganisms; Mouth - drug effects; Mouth - microbiology; Nursing; Oral hygiene; Oral Hygiene - methods; Oropharynx; Oropharynx - drug effects; Oropharynx - microbiology; Paediatric nursing; Paediatrics; Pathogens; Pediatrics; Pneumonia; Pneumonia, Ventilator-Associated - prevention & control; Secretions; Trachea - drug effects; Trachea - microbiology; tracheostomy; Translocation; Ventilator-associated pneumonia
• ISSN: 1362-1017; 1478-5153
• DOI: 10.1111/j.1478-5153.2012.00494.x

Background: Critical care nursing interventions to oral care can reduce microorganisms in the oropharynx available for translocation. Objectives: To analyse the effect of 0·12% chlorhexidine digluconate on the colonization of oropharyngeal and tracheal secretions by Gram‐negative pathogens in mechanically ventilated children. Methods: A randomized, controlled and double‐blinded study was performed in the paediatric intensive care unit (PICU) of a Brazilian university hospital. Exclusion criteria included child age under 28 days, pneumonia diagnosis at admission, use of tracheostomy, PICU length of stay (LOS) less than 48 h and refusal to participate. Children were randomly allocated to the interventional group (IG), in which oral care with chlorhexidine was administered, or to the placebo group (PG), which received oral care without antiseptic use. The data were analysed through Pearson's χ2 test, Fisher's exact and ANOVA tests with significance levels set at 0·05. Results: The demographic characteristics of the 74 children were not statistically different between groups. No between‐group differences in oropharyx colonization by Gram‐negative pathogens were identified (p = 0·316). Pathogens were isolated in the tracheal secretions of two (10·0%) children in the PG and four (19·0%) children in the IG (p = 0·355). Conclusion: The use of chlorhexidine did not significantly influence the colonization of oropharyngeal and tracheal secretions by Gram‐negative pathogens of the studied sample. Relevance to clinical practice: This study demonstrated no influence of a specific antiseptic agent on colonization profile of mechanically ventilated children in PICU. Further research in this field is necessary to promote evidence‐based nursing practice on oral care of critically ill children.