Chlorhexidine Gluconate Solution for VAP Prevention in ICU Patients

Research Proposal 1
Introduction of Chlorhexidine Gluconate Solution for Mouth Cares in order to reduce the
Incidence of Ventilator-Associated Pneumonia in an Adult Intensive Care Unit
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Research Proposal 2
Details
To establish the effects of Chlorhexidine Gluconate Solution in oral hygiene among
intensive care unit patients, fifty adults obtained from both sexes with endotracheal tube as well
as mechanical ventilation were presumed to be eligible for participating in the study. The
patients to be considered had to be intubated for at least 48 hours with the use of nasogastric tube
while having only one intubation attempt, no oral or facial trauma, or evidence showing VAP.
The study would go into showing how important oral hygiene is among patients in intensive care
units through the use of Chlorhexidine Gluconate Solution. According to research, it has been
established that Ventilator-associated Pneumonia (VAP) is one of the commonly acquired
infection in ICU wards and it is often associated with poor oral hygiene (Amanullah & Posner,
2015). Chlorhexidine Gluconate Solution is one of the top solutions that has been recommended
for use in this regard. This research proposal will go into exploring this subject further and find
out how effective Chlorhexidine Gluconate Solution is in the prevention of VAP in adult
intensive care units. The research design that would be applied is quasi-experimental in that there
will be two groups: the study group and the control group. The study group will use
Chlorhexidine Gluconate Solution while the control group will not, and the result compared to
give recommendations as required by the proposal design.
Overview
Ventilator-associated Pneumonia (VAP) is among one of the most common hospital-
acquired infections inside the intensive care units and is often associated with high morbidity and
significant cost of care. For many years, the epidemiology, pathophysiology, treatment as well as
prevention of VAP has been studied, but there has never been any clear prevention strategy
(Keyt et al., 2014 pg. 8). VAP is the occurrence of pneumonia in patients who are in the ICU

Research Proposal 3
receiving mechanical ventilation for more than 48 hours after endotracheal intubation (Kalanuria
et al., 2014). VAP in ICUs has many effects, some of which include: prolonged treatment with
mechanical ventilation, increased length of hospital stay, increased care costs and high mortality
rates (Hillier et al., 2013). Looking at the Australian Intensive care units, it has been estimated
that the incidence of VAP can occur roughly at 6.2 per every 1000 days of treatment using
mechanical ventilation. Based on estimates, VAP can occur in up to 28% of the ventilated
patients with each incidence of VAP attracting an increased cost of about $20,000 to $40,000
(Elliott et al. 2015). According to research, multiple interventions could be used and
recommended to reduce ventilator-associated pneumonia such as sedation holiday for the
mechanically ventilated patients, semi-recumbent position as well as regular oral care (Zhang et
al. 2017).
To reduce the risk of ventilator-associated pneumonia for the intubated patients in the
ICU, some measures have to be taken such as the provision of good oral hygiene, the use of
either a mouth rinse gel, toothbrush, solution or a combination of frequent suctions of the
sections (Ullman, 2009 pg. 51). VAP tends to arise when there is a bacterial invasion in the
pulmonary parenchyma for the patients receiving, mechanical ventilation (Pobo et al., 2010 pg.
21). VAP has become the foremost validation of why it is crucial for the patients in the ICU units
to get an oral cleaning (Kelly, 2014 pg. 20). Evidence has shown that inadequate mouth care for
the intubated patients could facilitate the aspiration of bacteria in the oropharyngeal secretions
and thus the cause of VAP (Dale, 2013 pg. 191). For this reason, the essential strategy for
reducing the risk of VAP is to improve oral health. Some of the techniques suggested for this
include removal of dental plaques as well as oral pathogens, the use of antiseptic solutions and
cuff pressure control, suctioning and lastly elevating the patient’s head of the of the bed by about

Research Proposal 4
35 to 45 degrees (Pobo et al., 2010 pg. 15). One practical solution that could be used for oral
hygiene is Chlorhexidine Gluconate Solution. Several studies have indicated that the use of
Chlorhexidine Gluconate Solution to be an effective way of preventing VAP (Mohammed &
Gamal, 2017). The use of this solution is safe, cost-effective, feasible, and easy to apply while
having minimal side effects. For that reason, the solution is in many circumstances considered to
be a crucial part of the ventilation care bundle (Par et al., 2014). For the hospitals to attain high
standards levels, they need to look at the current practices to help them in improving the patient's
outcome. As such, it can be recommended that the project proposal would be beneficial to the
patient as well as the facility (Gupta et al., 2016).
Aim
To expand on the knowledge that exists on the effectiveness of Chlorhexidine Gluconate
Solution in the prevention of VAP. The study, therefore, aims to examine the effects of the
solution on oral health status as well as the occurrence of ventilator-associated-pneumonia in
intubated ICU patients.
Objectives
To evaluate the effects of Chlorhexidine Gluconate Solution on ICU patients.
To use the solution for mechanically ventilated patients and compare them to a control ICU
patient group using alternative dental hygiene to establish how effective the Chlorhexidine
Gluconate Solution could be in the prevention of ventilator-associated pneumonia.
To collect and analyze data from previous research and comparing it to the research to expand
knowledge in establishing the effectiveness of Chlorhexidine Gluconate Solution in the
prevention of VAP