Efficacy of a Chlorhexidine-Based Oral Prevention Protocol in Reducing Ventilator-Associated Pneumonia in Pediatrics: A Controlled Before-After Study
Abstract
BackgroundVentilator-associated pneumonia (VAP) remains the second most common nosocomial infection in pediatric intensive care units, yet evidence-based prevention strategies specific to children remain limited.ObjectiveTo evaluate the efficacy of a multimodal VAP prevention bundle incorporating 0.12% chlorhexidine oral care in reducing VAP incidence among mechanically ventilated pediatric patients.MethodsControlled before-after study in the Gemelli PICU (January 2016-May 2019) including 162 patients aged 2 years, saline for younger children), head-of-bed elevation 30°-40°, biweekly microbiological surveillance, and daily weaning assessment. Primary outcome was VAP incidence using CDC/NHSN criteria.ResultsBundle implementation was associated with a 69.5% reduction in VAP incidence (20% to 6.1%, P = .01), decreasing from 3.3 to 1.0 VAP/100 ventilator-days. The number needed to treat was 7.2 patients. Protocol implementation reduced VAP risk (adjusted OR 0.23; 95% CI 0.07-0.81; P = .022). VAP-associated mortality was lower in the intervention group (0% vs 3.8% in controls). Duration of mechanical ventilation remained the strongest risk factor (OR 1.18 per day; 95% CI 1.08-1.29; P < .001). Pseudomonas aeruginosa was identified in 57.1% of VAP cases, with polymicrobial infections in 52.4%. All isolates remained antibiotic-susceptible.ConclusionsStructured implementation of an evidence-based VAP bundle may contribute to significant reductions in preventable VAP in pediatric…
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