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Clinton Valerio

BIOL 1615 College Biology Lab

Professor Jama

March 30, 2017

Scientific Article Summary

Article Title: Effect of Oral Hygiene and 0.12% Chlorhexidine Gluconate Oral Rinse in

Preventing Ventilator-Associated Pneumonia After Cardiovascular Surgery

Authors: Liliana Noem Nicolosi, Maria del Carmen Rubio, Carlos Daniel Martinez, Nidia

Noem Gonzlez and Marisa Edith Cruz

Pneumonia is a lung infection that causes the air sacs of the lungs to fill up with fluids

and/or pus. These are sacs are called alveoli. The development of pneumonia makes it hard for a

person to breathe which can result in not getting enough oxygen in the bloodstream. The main

causes of pneumonia are bacteria and viruses, but studies have shown that that a persons own

flora can be a source for the developing pneumonia. . The risk of contracting pneumonia while a

patient is trying to recovering from post-operative surgeries like cardiovascular surgery (CVS) is

relatively high and increases even more when that patient is placed on a ventilator, also called

endotracheal intubation. When a patient develops this type of pneumonia, it is referred to as

ventilator-assisted pneumonia (VAP).

VAP is a very serious post-op problem and has an impact for patients that can include but

is not limited to extended hospital stays, increased healthcare costs, and even death. VAP occurs

in about 9-27% of patients with endotracheal intubation. These percentages result in an 8-fold
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increase in the risk of death for patients who undergo CVS. Chlorhexidine is a disinfectant and

antiseptic that is used in many hospitals and healthcare settings. Chlorhexidine gluconate is a

byproduct of this and is used by dental professionals as a medication to treat gingivitis and

improve oral health.

The purpose of this study was to determine the effect of good oral health, by tooth

brushing, in combination with chlorhexidine gluconate oral rinses in decreasing and possibly

preventing the development of VAP after heart surgery.

The study was conducted on patients who were scheduled for CVS at the Spanish

Hospital of Buenos Aires in Argentina between January 2011 and December 2012. Patients were

divided into two groups; Group 1 consisted of patients who participated in an oral disinfection

procedure. This group was compared to Group 2, the controlled historical group, which consisted

of patients who underwent CVS between January 2009 and December 2010 at the same hospital,

with the same surgical team, ICU staff, and hospital-infection control personnel. Patients were

assessed by a dentist who determined oral health status and any dental treatment needs prior to

surgery.

Recordings of the development of VAP, cases of VAP diagnosed within 48 hrs. of

intubation or 72 hrs. after extubation were included in the findings. All infections that had

occurred after surgery were recorded and then sent to the hospital lab for microbiology and

bacteriology testing.

The study consisted of 210 patients that were scheduled for heart surgery. Under the

guidance of a dentist, 150 patients participated in an oral disinfection procedure prior to surgery.

This group was then compared with a group of another 150 patients that received heart surgery in
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previous years who did not participate in an oral disinfection procedure. The presence of post-op

infection was recorded and found that a lower number of occurrences of VAP were found in

Group 1 in comparison to Group 2. The results also found that the risk of developing VAP after

surgery was 3-fold higher in patients who did not participate in an oral disinfection procedure.

Length of hospital stay was also lower in Group 1 verses Group 2.

The study conducted shows that there is correlation between oral health and reducing the

risk of infection. Aspiration, or the breathing in a foreign body, from the upper digestive tract

was recognized as a key component in developing VAP. In conclusion, the combination of good

oral hygiene with the use of chlorhexidine oral rinses prior to cardio-vascular surgery proved

effective in reducing post-operative ventilator-assisted pneumonia.

This study was limited to just one hospital in Bueno Aires. The researchers who

conducted this study only focused on one course of surgical treatment for which patients were

put on a ventilator. Gender, age, or ethnicity were not identified in patients who received heart

surgery and patient health prior to surgery was not discussed. These findings should definitely be

confirmed in a larger pool of hospitals around the world with patients differing in age, gender,

ethnicity, location, and health status as well as other surgical treatments where patients are put on

ventilators.