Impact of oral hygiene protocols for critically ill patients on Pseudomonas aeruginosa, a major pathogen of ventilator-associated pneumonia: a randomized controlled trial

BACKGROUND: Prevention of ventilator-associated pneumonia remains a critical priority in intensive care. Oral hygiene status in critically ill patients receiving invasive mechanical ventilation plays a key role in the onset of ventilator-associated pneumonia, a common and serious infection associated with high mortality risk.

AIM: This work aimed to examine and compare the effects of different oral hygiene protocols for critically ill patients on Pseudomonas aeruginosa, a major pathogen of ventilator-associated pneumonia.

METHODS: The study included mechanically ventilated patients who received oral care according to two different protocols. Group 1 (n = 12) received treatment with 0.2% chlorhexidine. In group 2 (n = 12), the patients were treated using specialized oral care kits and an antiseptic based on an aqueous solution of electrochemically activated oxidants (Anolit ANK SUPER; Vitold Bakhir Electrochemical Systems and Technologies Institute, Russia). Samples were collected on days 1, 2, and 5 from all tooth surfaces, the sublingual area, the vestibular mucosa, and the oral cavity using sterile cotton swabs. The quantity of Pseudomonas aeruginosa, a Gram-negative pathogen causing ventilator-associated pneumonia, was measured before and after oral hygiene procedures using a microecological gas chromatography–mass spectrometry method with the Maestro-aMS system. Statistical analysis was performed using Statistica 10.0 and SAS JMP 11.

RESULTS: A statistically significant increase in Pseudomonas aeruginosa counts was observed in group 1 (16.0 [5.0; 86.5]), whereas no increase was detected in group 2 (2.50 [0; 26.25]) (10⁵ cell/g) (p = 0.0016). Oral hygiene with 0.2% chlorhexidine and specialized kits with an electrochemically activated oxidant–based antiseptic Anolit ANK SUPER demonstrated superior control of the pathogen burden.

CONCLUSION: Compared with the standard protocol with 0.2% chlorhexidine, oral-care management using specialized kits and an electrochemically activated oxidant–based antiseptic proved more effective in reducing colonization by Pseudomonas aeruginosa, a key pathogen of ventilator-associated pneumonia.