Antiseptics like Chlorhexidine are proved to be the effective means of oral decontamination. Chlorhexidine is a cationic chlorophenyl bis-biguanide antiseptic agent, which has the ability to bind to oral tissues and release antiseptic properties slowly, therefore, having a long period of antibacterial action. It is assumed that the pathogenesis of VAP starts with the development of pathogenic bacteria and colonization in the mouth cavity. These microorganisms are then aspired by the patient and may cause pneumonia. Nasogastric tubes are regarded as a contributing risk factor increasing the degree of bacterial colonization and facilitating entry of pathogenic bacteria to the lower respiratory tract. Many scholars and researchers theorize that this mechanism of VAP development is the most credible and medically viable. For example, Snyders, Khondowe and Bell suggest that, ‘Teeth should be considered a substantial reservoir for respiratory pathogens’. Koeman say that, ‘Oropharyngeal colonization with potentially pathogenic microorganisms’ is pivotal in the pathogenesis of VAP’. Pineda, Saliba and Sohl state that their laboratory tests based on molecular genotyping confirmed the association between pathogens colonizing dental plaques and those responsible for the development of VAP in mechanically ventilated patients and it is used in tests https://custom-writing-expert.com/services/online-test/
Thus, in addressing VAP in mechanically ventilated patients, health care professionals should address the source of the problem, i.e. decrease the oral bacterial load. Because of the proved antibacterial efficacy of Chlorhexidine, it should be used in VAP-preventive strategies. So, the theory of effectiveness of Chlorhexidine in VAP prevention is based upon the tested efficacy of oral decontamination with antiseptics and on the assumed and sporadically proved cause-effect linkage between oral contamination with pathogenic bacteria and development of VAP.
The abovementioned theoretical introspective and the evidence-based research provide enough reasons for choosing in favor of Chlorhexidine-based VAP-preventive medical interference. The available alternatives include toothbrushing, elevating the head of bed greater than 30 degrees, the use of iodine mouth swabs, silver coated endotracheal tubes, Bactroban nasal ointment, etc. Of these strategies, toothbrushing is proved to be one of the most ineffective. In contrast, one of the most effective and widely used methods is oral decontamination with antibiotics. However, despite the high degree of efficacy, the method is associated with enhanced risk of induction and selection of antibiotic-resistant pathogens. Moreover, the use of antibiotics is costly. According to the data, the majority of antibiotic use in ICUs is prescribed for treatment of respiratory tract infections, and estimated costs attributable to VAP were $11,897 in America alone. Therefore, the use of Chlorhexidine can be both life-saving and cost-effective.
The incorporation of the theory into the project can be achieved via introducing the practice of oral decontamination with Chlorhexidine (presumably a 0.1-2% rinse solution or gel) into the scenario of everyday care provided to mechanically ventilated patients. The practice must be applied two or three times a day. This method may be regarded as combinatory and used in complex besides raising the head of the bed to 45 degrees, etc.
