Application Of Daily Bathing By Chlorhexidine Combined With Nasal Instillation Of Amikacin On Preventation Of Ventilator-Associated Pneumonia In Intensive Care Unit

Objective:To evaluate the effect of daily bathing with chlorhexidine combined with nasal instillation of amikacin on prevent of entilator-associated pneumonia(VAP) in Intensive Care Unit(ICU).Methods:162patients which accepted tracheal intubation and invasive mechanical ventilation (MV) during Oct.2010to Dec.2011were enrolled in perspective investigation analysis. Patients were randomly divided into three groups with the ratio of1:1:1. The combined group(54patients) accepted both bathing with2%chlorhexidine twice a day and nasal instillation of amikacin (0.02g) three times a day,the instillation lasted a week. The Chlorhexidine bathing group(54patients) accepted bathing with2%chlorhexidine twice a day, while the control group(54patients) accepted only bathing with clear water twice a day. The VAP morbidity rate of the three groups were observed. To analyse VAP drug resistance,7common pathogens in ICU were selected(Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pnenmoniae, Escherichia coli, Pseudomonas maltophilia, Staphylococcus aureus, Enterococcus).Meanwhile, The clinical adverse events occurred in the application of chlorhexidine bathing were evaluated as well.Results:The VAP morbidity of combined group, chlorhexidine bathing group and control group was22.2%(12/54),25.9%(14/54),48.1%(26/54) respectively. The VAP morbidity of chlorhexidine bathing group and combined group was significantly lower than control group(P <0.05). There was no statistics difference of VAP morbidity between chlorhexidine bathing group and combined group(P>0.05).The MDRAB and MRSA morbidity of chlorhexidine bathing group and combined group were lower than that of blank controller(P<0.05).The drug resistance was no statistics difference among the3groups(P>0.05). After chlorhexidine bathing, there were only2cases appeared contact dermatitis, no anaphylactic shock, and medical staff did not occur with asthma and dyspnea.Conclusion:Application of daily bathing with chlorhexidine can be safe and effective in preventing ICU ventilator-associated pneumonia, and decreasing the morbidity of MDRAB and MRSA infection, with no risk of increasing bacterial resistance rate. There was no obvious advantage between bathing with chlorhexidine combined with nasal instillation of amikacin and only bathing with chlorhexidine in the prevention of ventilator-associated pneumonia in ICU. Although short-term nasal instillation of amikacin did not cause the increase of the rate of bacterial drug resistance, topical application of antibiotics is always one of the risk factors to cause pathogenic bacteria resistant elevated as time goes. In order to prevent bacterial resistance rate increased. Therefore, long-term application of nasal instillation of amikacin on the preventation of ventilator-associated pneumonia in Intensive Care Unit is not recommended.