The Effect of Oral Care with Miswak Versus Chlorhexidine on the Incidence of Ventilator-Associated Pneumonia: A Clinical Trial Study

Abstract

Background: Inadequate oral care in ICU patients can lead to lethal complications such as ventilator-associated pneumonia (VAP). Objectives: The purpose of this study was to compare the effect of oral care using miswak and chlorhexidine mouthwash on the incidence of VAP in ICU patients. Methods: This single-blind randomized clinical trial was carried out in 2018 on 70 patients undergoing mechanical ventilation in the intensive care units of Khatam-al-Anbia Hospital in Zahedan, Iran. The inclusion criteria were the insertion of endotracheal tube, scoring 10 or below based on Beck oral assessment scale (BOAS), scoring below 5 based on the modified clinical pulmonary infection score (MCPIS) at the beginning of the study, absence of chronic pulmonary disease, and no history of pulmonary aspiration. The subjects were selected through convenience sampling and randomly divided into the intervention (n: 35) and control (n: 35) groups. For five days, oral care was administered using miswak in the intervention group and chlorhexidine mouthwash in the control group. Data were collected through a demographic and clinical information questionnaire, MCPIS, and BOAS. After normality tests, the obtained data were analyzed in SPSS 22 using independent t-test, chi-square test, and Fisher’s exact test at the significance level of P < 0.05. Results: The two groups were similar in terms of age, gender, cause of hospitalization, level of consciousness, administered antibiotics, history of ICU admission, and smoking. After oral care with miswak, none of the patients in the intervention group developed VAP, but 6 patients in the control group (17.1%) were diagnosed with this condition. The results of Fisher’s exact test showed a significant difference between the two groups in terms of VAP incidence (P = 0.01). Conclusions: In addition to promoting the oral health of ICU patients, miswak can mitigate the incidence of ventilator-associated pneumonia. Therefore, because of its availability, cost-effectiveness, and fewer side effects compared to chlorhexidine mouthwash, it is strongly recommended to be administered to ICU patients.