Use Of Chlorhexidine Research Articles

Use of Chlorhexidine as an effective tool to control the spread of SARS-CoV-2 transmission: A Mini Review

The COVID-19 crisis, with its rapid spread and devastating effects on world economics, also had a crippling effect on health care systems that were already overburdened especially in a developing country like India which is in the midst of a second COVID-19 wave. Dentists particularly are among the most-at risk group of healthcare professionals. Their use of equipment like a dental drill, dental scaler etc., release aerosols that could be contaminated by the microbial flora from the infected patient’s oral cavity, thus, putting the dentist at risk. In such a setting, it would be prudent to use prophylactic measures. The six-decade-old Chlorhexidine (CHX) mouthwash with low toxicity and good broad-spectrum activity against bacteria, fungi and enveloped viruses could prove useful just before a dental procedure. The few completed studies of Chlorhexidine use in SARS-CoV-2 patients to reduce viral load show promising results. Hence, Chlorhexidine could be beneficial as a prophylactic measure for both asymptomatic and symptomatic SARS-CoV-2 patients due to its ability to target and reduce the viral load so that they do not contribute in further spreading of the virus. Moreover, CHX could be used on a regular basis to improve oral hygiene. Keywords Chlorhexidine (CHX), Covid-19, Dentists, Oral mouthwash, Saliva, SARS‐CoV‐2, Viral loadThe COVID-19 crisis, with its rapid spread and devastating effects on world economics, also had a crippling effect on health care systems that were already overburdened especially in a developing country like India which is in the midst of a second COVID-19 wave. Dentists particularly are among the most-at risk group of healthcare professionals. Their use of equipment like a dental drill, dental scaler etc., release aerosols that could be contaminated by the microbial flora from the infected patient’s oral cavity, thus, putting the dentist at risk. In such a setting, it would be prudent to use prophylactic measures. The six-decade-old Chlorhexidine (CHX) mouthwash with low toxicity and good broad-spectrum activity against bacteria, fungi and enveloped viruses could prove useful just before a dental procedure. The few completed studies of Chlorhexidine use in SARS-CoV-2 patients to reduce viral load show promising results. Hence, Chlorhexidine could be beneficial as a prophylactic measure for both asymptomatic and symptomatic SARS-CoV-2 patients due to its ability to target and reduce the viral load so that they do not contribute in further spreading of the virus. Moreover, CHX could be used on a regular basis to improve oral hygiene. Keywords Chlorhexidine (CHX), Covid-19, Dentists, Oral mouthwash, Saliva, SARS‐CoV‐2, Viral load

MILKING ANTISEPTICS AGAINST BACTERIA MULTIDRUG-RESISTANT BOVINE MASTITIS

This work aims to verify the in vitro action of antiseptics used in the pre- and post-dipping against multidrug-resistant bacteria from bovine mastitis. Antiseptic solutions in the concentration of use of iodine, chlorhexidine and sodium hypochlorite were tested against Staphylococcus aureus (n=12), Staphylococcus sciuri (n=1), Staphylococcus lentus (n=1), Streptococcus sp. (n=1), Enterococcus faecalis (n=1), Enterococcus casseliflavus (n=1), Kocuria kristinae (n=2), Kocuria varians (n=1). Was verified the Minimal Inhibitory and Bactericidal Concentration. The cytotoxicity test complemented the work. It was found that the Minimal Inhibitory Concentration and Minimal Bactericidal Concentration of the iodine, sodium hypochlorite and chlorhexidine was effective in the values recommended for use, however the presence of organic material reduced the activity of the tested products. Chlorhexidine showed higher efficiency of the other disinfectants.

ANTIBACTERIAL EFFECTIVITY TEST OF ULIN BARK EXTRACT (Eusideroxylon zwageri) ON THE GROWTH OF Porphyromonas gingivalis

ABSTRACTBackground: Chronic periodontitis is an infectious disease caused by bacterial colonization of dental plaque. Bacteria that play a role in chronic periodontitis is Porphyromonas gingivalis. One of mouthwash that reduce the number of P.gingivalis colonies is chlorhexidine 0.2%. Long term use of chlorhexidine 0.2% can cause some side effects to the oral cavity, so we need an alternative mouthwash from natural ingredients that can reduce the side effects of chlorhexidine 0.2%. Ulin bark extract contains phenolic, flavonoid, tannin, alkaloid, terpenoid, and saponin which can be an alternative base for mouthwash besides chlorhexidine 0.2%. Purpose: It is to analyze antibacterial effectivity of ulin bark extract on the growth of Porphyromonas gingivalis. Methods: This study was using true experimental research and post-test only with control group design, that used 9 treatment groups with 4 replications, that were 5%, 10%, 20%, 40%, 60%, 80%, 100% concentrations, chlorhexidine 0.2%, and sterile aquadest against P. gingivalis. The total samples were as many as 36. Result: One Way ANOVA and Post-Hoc Games Howell tests showed that the average absorbance values has a significant difference, then Kruskall Wallis and Post Hoc Mann Whitney tests showed the number of colonies with significant differences. MIC in this study was at 5% concentration and MBC was at 20% concentration.. Conclusion: Ulin bark extract with 40% concentration has an absorbance value equivalent to 0.2% chlorhexidine and 20% concentration has a bactericidal effects equivalent to 0.2% chlorhexidine against the growth of P.gingivalis.Keywords:Antibacterial, Dilution method,Porphyromonas gingivalis, Ulin Bark Extract.

Systemic antibiotic therapy as an adjunct to non-surgical peri-implantitis treatment: A single-blind RCT.

AimThe aim of this single‐blind RCT was to evaluate the adjunctive clinical and microbiological effect of systemic amoxicillin (AMX) plus metronidazole (MTZ) to non‐surgical treatment of peri‐implantitis.Material and methodsPatients (N = 62) with peri‐implantitis were randomly assigned to receive full‐mouth mechanical debridement and decontamination and use of chlorhexidine (control group) or combined with antibiotic therapy of AMX/MTZ (test group). Primary outcome was change in bleeding score from baseline (T 0) to 3‐month follow‐up (T 3). Secondary parameters were plaque, suppuration, PPD, CAL, bone level, microbiology, adverse events and need for additional surgery. Data were analysed with linear multiple regression analysis.Results57 patients with 122 implants completed 3‐month follow‐up. Both groups showed major clinical improvements at T 3 in both peri‐implant and periodontal parameters. However, no significant differences were observed between both groups for any of the primary or secondary parameters.ConclusionsSystemic antibiotic therapy of AMX/MTZ does not improve clinical and microbiological outcomes of non‐surgical peri‐implantitis treatment and should not be routinely recommended. Although complete disease resolution may be difficult to achieve, meticulously performed full‐mouth non‐surgical treatment, achieving a high level of daily oral hygiene and healthy periodontal tissues, can significantly improve the starting position of the subsequent (surgical) peri‐implantitis treatment phase.

Appropriate Use of Chlorhexidine in Oral Care

Appropriate Use of Chlorhexidine in Oral Care

Influence of the combined use of septomyrin and chlorhexidineon bacterial load of purulent wounds

Objective: to study the MIC90 of the most commonly used antiseptics for the main representatives of the microflora of purulent wounds and to study the influence of the most effective in vitro antiseptics on the bacterialload of the wound surface in patients with purulent wounds.Material and methods. Bacteriological studies determining the MIC90values of antiseptic drugs were performed on 70 clinical isolates. Clinical studies determining the level of the bacterial load of the wound surface were performed in 30 patients with purulent wounds.Results. Septomyrin and 0.02 % chlorhexidine bigluconate have been found to be the most active drugs against the main representatives of the microflora of purulent wounds in our region. In the combined use of septomyrin and chlorhexidine, the bacterial load of the wounds decreased below the critical level already 2 days after surgical debridement (p < 0.01), while in the single application of septomyrin, this had occurred only by the fifth day (p < 0.01), and chlorhexidine — by the sixth day (p<0.01).Conclusion. The combined use of septomyrin and 0.02 % chlorhexidine bigluconate is characterized by high clinical effectiveness in the local treatment of purulent wounds during the first phase of the wound healing process.

Evaluation of latex and non-latex intermaxillary elastics strength degradation when submitted to the use of chlorhexidine

ABSTRACT Purpose: To assess the influence of 0.12% chlorhexidine solution (CHX) in the strength degradation of different intermaxillary latex and non-latex elastics. Materials and methods: Eighty ¼ inch elastics were separated into eight groups (n = 10) according to manufacturers (Morelli™ and American Orthodontics™), elastic’s type (latex and non-latex) and storage solution (artificial saliva and CHX). Each sample was extended to 19.2 mm, corresponding to 3x the size of their inner diameter, and initial force was verified on the universal testing machine. The elastics were then kept extended, immersed in artificial saliva and their strength was once again evaluated in the following period of time: 12 and 24 hours. Following the storage period, elastics of CHX groups were immersed for 1 min into PerioGard (0.12% chlorhexidine solution) before the strength evaluation. The data (gf) was submitted to a three-way repeated measure analysis of variance and Tukey’s test (α = 0.05). Results: Significant differences between elastics and time were observed (p < 0.000). Statistically significant reduction in strength was found in non-latex and latex elastics between the initial condition and after 12 h and 24 h (p < 0.05). The non-latex elastics showed statistically higher degradation values than the latex elastics, in the three analysis times (p < 0.05). No statistical difference was found between saliva and CHX, regardless of the time and elastic type (p > 0.05). Conclusions: Generally, the latex elastics showed less strength degradation compared to non-latex elastics. CHX did not affect strength degradation and time influenced strength degradation in the first 12 hours, keeping practically constant for up to 24 hours.

Use of chlorhexidine to eradicate oropharyngeal SARS-CoV-2 in COVID-19 patients.

As public distribution of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is underway, prevention of coronavirus disease 2019 (COVID‐19) relies on minimizing spread. In this study, chlorhexidine gluconate was investigated as a topical antimicrobial agent against SARS‐CoV‐2. This was a randomized, prospective cohort study using chlorhexidine as an oral rinse and posterior oropharyngeal spray in hospitalized COVID‐19 patients. The primary outcome was presence or absence of laboratory‐confirmed SARS‐CoV‐2 in the oral and oropharyngeal cavities after 4 days of chlorhexidine use and standard of care (study group) or standard of care only (control group). SARS‐CoV‐2 was eliminated from the oropharynx in 62.1% of patients who used chlorhexidine as an oral rinse, versus 5.5% of the control group patients. Among patients who used a combination of oral rinse and oropharyngeal spray, 86.0% eliminated oropharyngeal SARS‐CoV‐2, versus 6.3% of control patients. Chlorhexidine is a simple and safe addition to current COVID‐19 prevention guidelines and may play a significant role in reducing disease spread.

Use of Chlorhexidine to Eradicate Oropharyngeal SARSCoV-2 in COVID-19 Patients

Objective: As public distribution of a vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is in underway, prevention of coronavirus disease 2019 (COVID-19) relies on minimizing spread. In this study, chlorhexidine gluconate was investigated as a topical antimicrobial agent against SARS-CoV-2. Methods: This was a randomized, prospective cohort study using chlorhexidine as an oral rinse and posterior oropharyngeal spray in hospitalized COVID-19 patients. The primary outcome was presence or absence of laboratory-confirmed SARS-CoV-2 in the oral and oropharyngeal cavities after four days of chlorhexidine use and standard of care (study group) or standard of care only (control group). Results: SARS-CoV-2 was eliminated from the oropharynx in 62.1% of patients who used chlorhexidine as an oral rinse, versus 5.5% of the control group patients. In patients who used a combination of oral rinse and oropharyngeal spray, 86.0% eliminated oropharyngeal SARS-CoV-2, versus 6.3% of control patients. Conclusions: Chlorhexidine is a simple and safe addition to current COVID-19 prevention guidelines and may play a significant role in reducing disease spread.

Efficiency of different protocols for oral hygiene combined with the use of chlorhexidine in the prevention of ventilator-associated pneumonia

ABSTRACTObjective:In ICU patients on mechanical ventilation (MV), ventilator-associated pneumonia (VAP) is a common infection. However, such infection can be prevented through oral care protocols. The objective of this study was to compare the efficiency of the use of chlorhexidine and oral hygiene protocols (brushing and clinical procedures) with that of the use of chlorhexidine alone (intervention group and control group, respectively) in decreasing the prevalence of VAP in patients ≥ 18 years of age admitted to the ICU and requiring MV. Methods:In this systematic review and meta-analysis, studies were identified through searches of various national and international databases, as well as of the gray literature, and were selected in accordance with eligibility criteria. Results:We evaluated six studies, involving a collective total of 1,276 patients. We classified the risk of bias as low in three studies, high in two, and uncertain in one; among the six risk domains evaluated, a low risk of bias was predominant in five. The results for random risks were similar in terms of direction and statistical magnitude-chi-square = 6.34; risk difference: −0.06 (95% CI: −0.11 to −0.02); I2 = 21%; p = 0.007. There was a decrease in the prevalence of VAP in the intervention group (n = 1,276) included in the meta-analysis. Conclusions:Protocols that include the mechanical removal of oral biofilm in combination with the use of chlorhexidine can reduce the incidence of VAP among ICU patients requiring MV.

Consensus Report by the Italian Academy of Osseointegration on the Use of Antibiotics and Antiseptic Agents in Implant Surgery.

Beneficial aspects of short and ultrashort antibiotic administration protocols could be clinically correlated to the reduced side effects on the gastrointestinal microflora. The aim of this Consensus Conference was to establish the necessity of an antibiotic prophylaxis and its dosage to reduce the risk of early implant failure in healthy (ASA 1 or 2), periodontally healthy patients, undergoing basic dental implant surgery (straightforward cases). Additionally, the need for an antiseptic protocol, used before and after the implant surgery, was evaluated. Active members of the Italian Academy of Osseointegration (IAO), together with several worldwide-recognized key opinion experts in the field of microbiology, implant dentistry, and infectious diseases, were participants at this Consensus Conference. Two systematic reviews were carried out, before the Consensus Conference, and their results discussed in order to give guidelines on the administration of an antibiotic/antiseptic prophylaxis in implant surgery. The systematic reviews covered the following topics: (1) the use of antibiotics to reduce both implant failure rate and peri-implant infections in healthy patients and (2) the use of chlorhexidine compositions capable of reducing complications in patients undergoing surgical interventions. The main statements reached by the assembly were as follows: (1) Rinsing with chlorhexidine is highly recommended before and after implant surgery to minimize the bacterial load. (2) A single dose of antibiotics in straightforward cases is recommended. (3) In complex cases (long surgical time, regeneration procedures), it is advisable to continue the antibiotic administration. This Consensus Conference advocates the administration of a unique dose of antibiotics in straightforward implant cases combined with the use of chlorhexidine.

Susceptibility to chlorhexidine and mupirocin among methicillin-resistant Staphylococcus aureus clinical isolates from a teaching hospital.

ABSTRACTDespite the widespread use of chlorhexidine (CHX) to prevent infection, data regarding the in vitro action of CHX against methicillin-resistant Staphylococcus aureus (MRSA) are limited. Clinical isolates from Hospital das Clinicas, Sao Paulo, Brazil, identified during 2002/2003 and 2012/2013 were studied to describe the susceptibility to CHX and mupirocin, molecular characteristics, and virulence profile of MRSA. Susceptibility test to Mupirocin was performed by the disk diffusion method and to CHX by the agar dilution technique. PCR for virulence genes, mecA gene and Staphylococcal Cassette Chromosome mec (SCCmec) types were investigated as well. Mupirocin- and CHX-resistant isolates were sequenced using the IlluminaTM plataform. Two hundred and sixteen MRSA clinical isolates were evaluated: 154 from infected and 62 from colonized patients. Resistance to mupirocin was observed in four isolates assigned as SCCmec type III and STs (ST05; ST239 and ST105) carrying mupA and blaZ, two of them co-harboring the ileS gene. Only one isolate assigned as SCCmec type III was resistant to CHX (MIC of 8.0 μg.mL-1) and harbored the qacA gene. Resistance to chlorhexidine and mupirocin were found in isolates carrying qacA and mupA in our hospital. Since these genes are plasmid-mediated, this finding draws attention to the potential spread of resistance to mupirocin in our hospital.

634. Chlorhexidine Oral Rinses to Alter the Oral and Sputum Microbiota in COPD (CLIMB): a Randomized, Double-blinded, Placebo-controlled, Parallel-group Pilot Study

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive, inflammatory lung disease with few available disease-modifying therapies. Acute exacerbations of COPD (AECOPD) increase morbidity and mortality, and their occurrence coincides with sputum and oral microbiota dysbiosis. The oral microbiota also serves as the source of the lower airway microbiota. Chlorhexidine oral rinses are known to alter the oral microbiota. We hypothesized that subjects randomized to 8 weeks of chlorhexidine oral rinses (vs. placebo) will demonstrate decreased microbiota biomass compared to baseline and those on placebo.MethodsWe performed a randomized, double-blind, placebo-controlled, 8-week study of the effects of twice-daily chlorhexidine oral rinses on 44 subjects with COPD. Baseline and post-treatment data were obtained evaluating oral and sputum microbiota biomass and composition, systemic inflammation (CRP, fibrinogen, and WBC count), and respiratory symptoms (Breathlessness, Cough, and Sputum Scale [BCSS], St. George’s Respiratory Questionnaire [SGRQ], and AECOPD assessment). All analyses were prespecified. ResultsForty of 44 participants completed the study. The primary analysis of the mean differences in oral and sputum microbiota biomass between treatment groups was not significant. Chlorhexidine use was associated with a decrease in oral and sputum microbiota alpha diversity compared with placebo (Shannon diversity index change [standard error]: -0.349 [0.091] and -0.622 [0.169] respectively; padj=0.001 for both). There was no significant change in CRP, fibrinogen, WBC count, or BCSS score between treatment groups over the study period. Chlorhexidine use was associated with a significant improvement in SGRQ score when compared to the placebo (mean change ± standard deviation: chlorhexidine -4.7 ± 8.0 vs. placebo 1.7 ± 8.9, p=0.011; minimal clinically important difference in SGRQ score -4). Few adverse events were reported. ConclusionAmong those with COPD, use of twice-daily chlorhexidine oral rinses resulted in decreased oral and sputum microbiota alpha diversity and clinically significant improvement in COPD symptoms. Chlorhexidine use did not result in decreased oral or sputum microbiota biomass or decreased systemic inflammation.Disclosures All Authors: No reported disclosures

Efficacy of ultrasonic mechanical instrumentation with and without chlorhexidine in treatment of chronic periodontitis

Aim: The aim of the present study was to evaluate the effects of ultrasonic mechanical instrumentation (UMI) along with the professional use of chlorhexidine (CHX) compared with UMI alone during periodontal supportive therapy in patients with chronic periodontitis. Material and Methods: A total of twenty patients were included in the study and were divided into test and control group. The test group (ten patients) was treated with a single session of UMI along with subgingival irrigation under cavitation with CHX 0.02%. A 0.2% CHX solution was used for professional tongue brushing and mouth rinsing. The control group (ten patients) received a similar single session of UMI along with subgingival irrigation and professional tongue brushing and mouth rinsing with a control formulation. Clinical and microbiological parameters were assessed pre-treatment at 3 and 6 weeks post­treatment. Results: Results showed that there was a significant reduction of supragingival plaque and gingival inflammation as well as a significant reduction of subgingival bacterial pathogens in both test and control groups. The additional use of CHX did not result in any additional clinical and microbiological benefit with respect to UMI alone. Conclusion: CHX formulations in conjunction with UMI seems to produce no additional benefits over UMI alone during supportive therapy in chronic periodontitis patients. Keywords: Chlorhexidine, Chronic Periodontitis, Piezoelectric Ultrasonic, Subgingival Microbiota.

COVID-19 and Oral Surgery: A narrative review of preoperative mouth rinses.

ObjectiveTo provide a narrative review of the preprocedural mouth rinse protocols suggested for oral surgery in order to contrast the presence of SARS-CoV-2 in aerosol.Sources and MethodsElectronic searches were performed in medical databases PubMed, Medline, CINAHN and Scopus to identify relevant studies published up until the third week of April 2020. This research was supplemented by exploration through a web-based search engine as well as a manual search for international and national guidelines. Studies and protocols which suggested preoperative mouth rinsing as a recommended measure during the COVID-19 outbreak were included. Given the small number of studies, a narrative literature review was conducted. In total, 15 references (11 articles and 4 guidelines) were considered relevant and were critically analysed.ConclusionThe findings show a high heterogeneity in the protocols suggested. Further research is required to better understand the viral features and epidemiologic characteristics of this new virus and to test the efficacy of commonly used antiseptics against SARS-CoV-2 in future clinical trials. However, the use of chlorhexidine, hydrogen peroxide, PVP-I and cetylpyridinium chloride in contrasting the spread of Covid-19 is described as advisable and substantial in different publications.

Efficacy of 4% chlorhexidine in preventing neonatal umbilical cord infection

Background: Umbilical cord stump is a budding point for bacterial colonization subsequently leading to sepsis that contributes to high neonatal morbidity and mortality, if not properly managed. Antiseptic care can significantly reduce omphalitis and ultimately improve newborn survival. Objective of this study was to see the efficacy of 4% chlorhexidine use to prevent umbilical cord infection in neonates.Subjects and methods: It was a comparative analytical study conducted in Neonatal unit, Sir Ganga Ram Hospital (SGRH) Lahore from July, 2016 till January, 2017. One hundred neonates were enrolled and randomized into two equal group by simple random method (50 each). In one group, nothing was applied to cord while in chlorhexidine group, 4% chlorhexidine gel was applied on umbilicus and around it, once daily for 7 days or till cord detached whichever came early. First application was done by a nurse followed by duly trained mother/caregiver. The signs of omphalitis (redness, pus or localized oedema) were observed and recorded for each neonate in both groups. Chi square test was used to see the difference in omphalitis in these groups with p˂ 0.05 considered as statistically significant result.Results: Out of 100 neonates, 29 (58%) and 23 (46%) males while 21 (42%) and 27 (54%) females neonates belonged to dry care and chlorhexidine group respectively. Nineteen (38%) neonates with dry cord had omphalitis compared to only 5 (10%) in chlorhexidine group (p 0.001). Neonates with chlorhexidine application showed prolonged mean cord separation time (7.9±1.5 days) compared to dry care (6.1±1.8 days). Conclusion: The use of 4% Chlorhexidine was effective to lower omphalitis compared to neonates with dry cord care.

Two per cent alcoholic chlorhexidine versus alcoholic five per cent povidone-iodine for the prevention of perineural catheter colonisation: The CHLOVEPI randomised, controlled trial

BackgroundMultimodal analgesia, including a regional technique using perineural catheters (PNCs), is recommended for the treatment of moderate-to-severe acute postoperative pain. Perineural catheters are at risk of bacterial colonisation. In this study, we compared the cutaneous antiseptic efficacy of 2% alcoholic chlorhexidine and povidone-iodine-alcohol for preventing the bacterial colonisation of PNCs in orthopaedic surgery. MethodsWe performed a randomised, controlled trial, comparing two cutaneous antisepsis strategies, one based on 2% alcoholic chlorhexidine and the other on povidone-iodine-5% alcohol, for placed PNCs before orthopaedic surgery. The primary endpoint was the incidence of catheter bacterial colonisation (threshold > 1000 colony-forming units/ml). The secondary endpoints were the incidence of catheter-related infections and the adverse effects of the antiseptic solutions. ResultsFrom November 2016 to May 2018, we included 113 patients in this study. The use of alcoholic chlorhexidine was associated with a lower incidence of catheter colonisation (15.5% (n = 9) versus 32.7% (n = 18); OR: 0.28 [0.09-0.77], p = 0.01). No catheter-related infections or adverse effects of antiseptic solutions were observed in either group. The risk factors associated with colonisation were a duration of catheter use ≥ 3 days (p = 0.04) and obesity (p = 0.005). The most frequently identified bacterium was Staphylococcus epidermidis. ConclusionSkin disinfection with 2% alcoholic chlorhexidine decreases bacterial colonisation rates for placed perineural catheters.

Polishing can reduce discoloration of the nanofiller composite resin filling due to the use of chlorhexidine

Nanofiller composite resin (NCR) restoration has a major problem, namely color changes. Polishing are factors that determi-ne color change and if accompanied by the use of mouthwash for a long time can cause more significant color changes. The 0.2% chlorhexidine gluconate mouthwash is a mouthwash that is often used in the community because it has low toxicity. However, using the chlorhexidine gluconate 0.2% mouthwash in the long term can cause more significant discoloration. This study is aimed to determine the difference between discoloration of polished and unpolished NCR on the soaking of 0.2% chlorhexidine gluconate mouthwash. This purely experimental research with a pretest and posttest with control group design, using 24 samples of premolar teeth prepared with class II cavity design and then filled with NCR. The samples were then di-vided into 4 treatment groups, namely polished and non-polished NCR, 0.2% chlorhexidine gluconate mouthwash and aqua-dest. Soaking was carried out 24 hours a day for 5 days in an incubator at 37ºC. Color changes of each group were measured using shade guide Vita Classical. The results were analyzed descriptively and the normality was tested by the Shapiro-Wilk and Levene's homogenity test with significance value of 0.05. Mann-Whitney for the different test. Based on the results of this study, it is concluded that the discoloration of the polished NCR was smaller than that was not polished on the soaking of chlorhexidine mouthwash 0.2%

Kajian Literatur: Perawatan Mulut sebagai Intervensi Pencegahan Ventilator-Associated Pneumonia pada Pasien Kritis

Introduction: Ventilator-Associated Pneumonia (VAP) is a nosocomial pneumonia which develops after the patient received 48 hours of mechanical ventilation intubation. VAP raises various problems such as prolong length of stay and ventilator time, increase treatment costs, and increase risk of death. Appropriate and effective oral care is one of the nursing interventions that can reduce the incidence of VAP. The aim of this study was to identify procedure of oral care for prevention of VAP in critical patients. Methods: This research method is a literature review. Literature is searched through electronic database such as EBSCOhost, Scopus, Science Direct, and Proquest. The inclusion criteria of article were randomized controlled trials or randomized clinical trial designs, evaluate oral care effects on the prevention of VAP in critically ill patients, full text articles and publication years from January 2013 to May 2020. Results: Search results found as many as 38 articles, but only 9 articles were eligible to be reviewed. This review indicate that oral care has a significant effect on the prevention of VAP. The combination of toothbrush and swab is the most appropriate equipment. Chlorhexidine 2% was the most influential solution in reducing the incidence of VAP, while the frequency of oral care was most effective when adjusted to the results of the Back Oral Assessment Score (BOAS). Conclusion: This result reinforces the use of chlorhexidine in the oral care of mechanically ventilated patients. Oral care assessment needs to be done by nurses to guide in determining the frequency of oral care.

Abstract 15746: Chlorhexidine Irrigation Without Capsulectomy After Device and Lead Extraction in Patients With Cardiac Implantable Device Infection

Introduction: Pocket management after device removal is unclear in patients with cardiac implantable electronic devices (CIEDs) infection. Capsulectomy has been proposed to reduce the risk of reinfection, this procedure is time consuming and requires extensive tissue debridement with a potential higher risk of hematoma formation. Hypothesis: The use of chlorhexidine and saline pocket irrigation without capsulectomy is effective in the management of CIED related infection. Methods: Patients who underwent transvenous lead extraction without capsulectomy for CIED-related infection were included. After complete hardware removal, thorough scrubbing of the generator pocket with 20 cc of 2% chlorhexidine followed by irrigation with 1L of saline was undertaken. The pocket was dried using sterile drapes and the wound was closed with separate intradermal absorbable suture. Implantation of a new CIED device and antibiotic treatment were given according to treating physicians’ discretion. Patients were followed up for 6 weeks after the procedure, and then every 6 months. Results: Between July 1 st , 2013 and May 1 st , 2019, 34 patients (68.1±10.6 years; 13 female) were included. Median follow-up was 745.5 days (IQ range 444.5-1418 days). Lead or device extrusion (41%) was the most frequent indication for extraction. Additionally, 38% of patients had endocarditis. In 75% of cases, bacteria were isolated from blood, pocket or lead tip cultures. Gram positive bacteria were the most frequently found organisms (59% of cases). In total, 19 patients (56%) had a new device implanted after the procedure; mean follow-up for this group of patients was 1251.1±678.8 days. Average time between device extraction and implant of a new device was 26 days, with 11 patients (32%) having device implant in the following week after extraction, including three patients (9%) who underwent dual chamber pacemaker immediately after lead extraction. There were no immediate or 30-day complications associated with chlorhexidine use. During follow-up, no patients presented recurrent infection. Conclusions: The use of chlorhexidine and saline pocket irrigation without capsulectomy offered excellent results with no cases of reinfection and without taking the risk of hematoma formation.