Efficacy of Chlorhexidine in Reducing Oral Colonisation in the Geriatric Population

Table of Content

Introduction

Oral colonisation resulting from poor oral care is one of the factors that cause aspiration pneumonia in the geriatric population.  An increase in respiratory pathogens in the oral cavity has been reported to heighten the risk of aspiration pneumonia in geriatric patients. Chlorhexidine is an effective agent in reducing oral colonisation and hence the incidence of pneumonia.

Aim

To evaluate the effects of chlorhexidine compared to routine oral care in edentulous geriatric inpatients.

Patient profile

Patients aged ≥ 65 years who had been admitted to the geriatric unit, were edentulous with or without dentures and had functional impairment

Methods

Study Design

  • Double-blind, parallel-group randomised controlled trial
  • A total of 90 patients who fulfilled the criteria were recruited

  • All participants received oral care from nurses with their assigned solution for seven days (20 mL once daily)
  • Before each oral care procedure, oral cavity assessment using the Brief Oral Health Status Examination form was performed
  • Data on medication received, and the subsequent development of aspiration pneumonia was recorded
  • On Day 7, after the oral care procedure, oral swabs were taken from the buccal, occlusal and lingual sides for culture and sensitivity, to determine the colonisation of microorganisms

Results

Table 1: Baseline characteristics

Characteristic

No. (%)

Stat (df)

pvalue

CHX

(n = 43)

Thymol

(n = 35)

Age (yr)

81.2 ± 9.1*

79.9 ± 6.6*

0.64 (76)

0.142

Gender

 

 

0.26 (1)

0.612

Male

16 (37.2)

15 (42.9)

 

 

Female

27 (62.8)

20 (57.1)

 

 

Race

 

 

1.04 (2)

0.594

Malay

12 (27.9)

9 (25.7)

 

 

Chinese

26 (60.5)

19 (54.3)

 

 

Indian

5 (11.6)

7 (20.0)

 

 

Source of

admission

 

 

0.55 (2)

0.761

Other ward

7 (16.3)

5 (14.3)

 

 

Home

29 (67.4)

22 (62.9)

 

 

Nursing home

7 (16.3)

8 (22.9)

 

 

Length of stay

(day)

14.5 ± 14.4*

14.1 ± 7.1*

0.15 (76)

0.061

Baseline oral

cavity score

1.5 ± 1.3*

1.7 ± 1.3*

0.79 (76)

0.427

Baseline swab

(CFU/mL)

 

 

2.30 (2)

0.317

 

 

 

 

< 50

7 (16.3)

5 (14.3)

 

 

50–200

16 (37.2)

8 (22.9)

 

 

> 200

20 (46.5)

22 (62.9)

 

 

*Data presented as mean ± standard deviation. Statistical analysis performed using †independent ttest; ‡chisquare test. CFU: colonyforming unit; CHX: chlorhexidine group; df: degrees of freedom; thymol: thymol gargle group

  • The oral colony count was significantly reduced after oral care compared to the baseline count (p < 0.001)
  • In chlorhexidine group, about 32 (74.4%) patients showed a reduction in oral colonisation from the baseline results compare to only 9 (25.7%) patients in the control group showed a reduction in oral colonisation from baseline to post oral care
Table 2. Baseline and post oral colonisation by group

Oral

colonisation*

(CFU/mL)

No. (%)

chisquare pvalue

CHX

(n = 43)

Thymol

(n = 35)

(df)

 

Baseline

 

 

2.30 (2)

0.317

< 50

7 (16.3)

5 (14.3)

 

 

50–200

16 (37.2)

8 (22.9)

 

 

> 200

20 (46.5)

22 (62.9)

 

 

Postoral care

 

 

20.54 (2)

< 0.001

< 50

32 (74.4)

9 (25.7)

 

 

50–200

6 (14.0)

7 (20.0)

 

 

> 200

5 (11.6)

19 (54.3)

 

 

*Data presented as mean ± standard deviation. Statistical analysis performed using †independent t-test; ‡chi-square test. CFU: colony-forming unit; CHX: chlorhexidine group; df: degrees of freedom; thymol: thymol gargle group

  • The results also revealed that oral colonisation in the control group did not differ significantly at baseline and post oral care (p = 0.375)
  • The control group, who received routine oral care solutions, had nearly a three-fold risk of developing oral bacterial colonisation was compared to the intervention group
  • According to BOHSE results, no significant difference between the two groups (p=0.165) after the intervention  
  • No side effects were observed in any participants during the study period
    • Bitter taste upon application was reported in 2 patients from the intervention group

Conclusion

  • The study demonstrated a beneficial and statistically significant effect from oral care with chlorhexidine mouthwash in reducing oral colonisation in these geriatric patients
  • The use of chlorhexidine 0.2% significantly reduced oral colonisation
  • Moreover, researchers noted nearly a three times higher risk of oral bacterial colonisation in the control group compared to the intervention group
  • According to study researchers, it is recommended as an easier and more cost-effective alternative for oral hygiene
  • The findings highlight the importance of establishing standardised strategies in oral hygiene

Reference

Singapore Med J 2016; 57(5): 262-266