Effectiveness of Oral Care with Antiseptics in Preventing Ventilator Associated Pneumonia

Running head: VENTILATOR ASSOCIATED PNEUMONIA
VENTILATOR-ASSOCIATED PNEUMONIA
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ASSESSMENT 3B: PROJECT FINAL OUTPUT
TITLE OF SYSTEMATIC REVIEW
A summary of systematic review on effectiveness of oral care with
antiseptics to prevent ventilator associated pneumonia in patients on
mechanical ventilation

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Executive Summary:
Background: The report revolves around the condition of Ventilator Associated Pneumonia
that is considered as the most prevalent nosocomial infection with a high mortality rate.
Pseudomonas aeruginosa and Staphylococcus aureus are the microorganisms responsible for
causing ventilator Associated Pneumonia. The above mentioned pathogens reside in the oral
cavity of the patient thus the patient receiving mechanical ventilation are not allowed to
consume food orally there reducing the overall salivary secretions. Various interventions are
used to overcome the issue of ventilator associated pneumonia.
Objectives: The primary focus of this study is to evaluate the effectiveness of oral care
intervention in preventing the condition of ventilator associated pneumonia. In this procedure
the mouth of the patient is kept clean and devoid of any bacterial contamination.
Inclusion criteria: Various systematic study is conducted that will highlight the
effectiveness of using oral care as the intervention in preventing ventilator associated
pneumonia for the patient on mechanical ventilation and is included in the study. The paper
focusing on the patient present ion mechanical ventilation without any gender and age
limitation are included in the study.
Types of Participants: The participants included in the study were critically ill-patient who
were on mechanical ventilation irrespective of their sex or age for approximately 48 hours or
more.
Types of intervention: The intervention will be included for the study focusing on
effectiveness of oral care with antiseptic in preventing ventilator associated pneumonia for
patient on mechanical ventilation. The study focusing on any other intervention other than
oral care with antiseptic will be omitted from the study. A control group is established to

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relate and compare the articles based on systematic review and accordingly the outcomes will
be assessed.
Type of Studies: All systematic review articles are included in this study.
Outcome Measure: The outcome was evaluated from the prevalence rate of VAP, total
period of hospital stay, total period of mechanical ventilation and patient present in intensive
care unit.
Search Strategy: Electronic databases are used as the search strategies to extract the relevant
articles. MEDLINE, COHRANE LIBRARY, CINAHL PLUS and JONNA BRIGGS
INSTITUTE are the electronic databases used in the study. Appropriate keywords and terms
are used and the search is limited to the peer-reviewed articles, English language and latest
publication year.
Methodological quality: In order to assess the quality of methodology of the study a critical
appraisal tool is used. AMSTAR checklist tool is used to assess the quality of extracted
journal articles and accordingly the data is extracted from the most relevant journal articles
used in the study.
Data extraction: The data were extracted in this systematic review study by using various
specific key words. The keywords were precise and accurate and explained specific
intervention related to VAP and extracted outcome that would fulfil the objective of the
study.
Data synthesis: This systematic review offered the data synthesis in a narrative form that
included exploration and discussion of the result which focused on assessing the efficiency of
oral mouth care using chlorhexidine.

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Result: Result is included based on the relevance of the article and the findings that each
article suggest. It was extracted that if 2% of chlorhexidine is used by the patient four times a
day associated with effective oral mouth care it will help the patient to overcome from the
issue of ventilator associated pneumonia.
Conclusion: From this systematic review of research article it was observed that oral mouth
care associate with chlorhexidine at 2% concentration taken three times per day is proved to
be highly effective in treating and preventing the risk of ventilator associated pneumonia
(VAP).

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Table of Contents
BACKGROUND:......................................................................................................................7
OBJECTIVE............................................................................................................................10
CONDITIONS FOR CONSIDERING STUDIES FOR THIS REVIEW................................10
Types of studies:..................................................................................................................10
Types of participants:...........................................................................................................10
Types of interventions:.........................................................................................................10
Control group in the study:..................................................................................................11
Types of outcome measures.................................................................................................11
Search Strategy.........................................................................................................................11
Methods of the review..............................................................................................................13
Valuation of methodology quality:......................................................................................13
Data extraction.....................................................................................................................13
Data synthesises...................................................................................................................14
Result........................................................................................................................................14
Paper selection process........................................................................................................14
Discussion................................................................................................................................18
Conclusion................................................................................................................................20
Implication for practice............................................................................................................21
Implication for research...........................................................................................................21
References................................................................................................................................22
Appendixes...............................................................................................................................28

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Appendix A: Proposed Timeframe..........................................................................................28
Appendix B:.............................................................................................................................29
Appendix C: List of excluded articles......................................................................................30
Appendix D: AMSTAR Critical appraisal form......................................................................33
Appendix E: Data Extraction Form..........................................................................................34
Appendix F: Gantt chart...........................................................................................................36

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BACKGROUND:
Ventilator Associate d Pneumonia (VAP) is considered as the most common
nosocomial contaminations with high mortality rate (Sadasivan et al., 2018). VAP endures to
be an important medicinal issue with high death rate that range among 33% to 50% in spite of
the current developments in the treatment and diagnosis of Ventilator Associated pneumonia
(Villar et al., 2016). The microbes responsible for the development of VAP are Pseudomonas
aeruginosa and staphylococcus aureus. The above mentioned pathogens leading to the
condition of VAP resides in the oral cavity or mouth of the patients, who are under critical
care condition (Haghighi et al., 2017). Due to lack of oral consumption of food among
patients living in mechanical ventilation, the amount of salivary secretions is reduced in such
patients that decreases the self-cleaning method of oral cavity in mouth that is responsible for
increasing the overall bacterial count in such patient. Therefore, it leads to colonisation of
bacteria in oropharynx (Kaya et al., 2017). Hence, it is evident from the result that
orpharyngeal tract is the primary cause of ventilator associated pneumonia (VAP).
Various interventions are present that can be used to overcome or treat the condition
of ventilator associated pneumonia and primarily focus on the intervention of oral cares
associated antiseptics in the patients suffering from this condition in mechanical ventilation.
The intervention of oral care is used as it was seen that ventilator associated pneumonia takes
place or affect people through their endotracheal tube, micro aspiration and open mouth tube
during their oral mouth secretions (Chacko et al., 2017). According to Yeganeh et al., (2019)
poor suctioning and bad oral care is connected with the high or increased prevalence rate of
ventilator associated pneumonia (VAP). There are various types of complications present in
case of ventilator pneumonia that includes empyema, lung abscess and bacteria. The risk of
Ventilator Associated Pneumonia is primarily developed because of different elements