Effect of oral care in reducing the incidence of early-onset ventilator-associated pneumonia in preterm infants.

Background: Oral care using chlorhexidine has been considered useful in reducing the incidence of ventilator-associated pneumonia (VAP) in adult patients. However, no study has proved the effect of oral care in reducing the incidence of VAP in preterm infants.

Objectives: To investigate the efficacy of oral care using a sponge brush moistened with sterile water in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants METHODS: The bacterial number in the oral cavity was evaluated on-site with the dielectrophoretic impedance measurement system. Bacterial numbers before and after oral care were investigated prospectively. Then, the incidence of early-onset VAP was compared retrospectively between infants who received oral care before re-intubation and those who did not.

Results: The mean bacterial number (cfu/ml) in the oral cavity in infants managed with endotracheal intubation (n = 23), continuous positive airway pressure (n = 38), and high-flow nasal cannula (n = 22) significantly reduced (p < .01) after versus before oral care (4.46 × 10 vs. 1.25 × 10 ; 1.32 × 10 vs. 6.82 × 10 ; and 1.68 × 10 vs. 6.50 × 10 ). The incidence rate of early-onset VAP after re-intubation was 51% (20/39) in patients who did not receive oral care. Then, it significantly decreased to 21% (7/33; p = .009) after receiving oral care.

Conclusion: Oral care with sterile water may be effective in reducing the bacterial load in the oral cavity and the incidence of early-onset VAP in preterm infants.