Research Article

Development and Implementation of a Chlorhexidine-Based Oral Hygiene Protocol to Prevent Ventilator-Associated Pneumonia in ICU Patients: A Quasi-Experimental Study

Abstract

Background: Ventilator-associated pneumonia (VAP) represents a major complication in mechanically ventilated ICU patients, driven by poor oral hygiene that promotes oropharyngeal pathogenic colonization. Standardized protocols are essential for effective VAP prevention in nursing care. This study developed and implemented a chlorhexidine-based oral hygiene protocol and evaluated its effectiveness against eucalyptol in reducing VAP risk.
Methods: A quasi-experimental nonequivalent control group posttest-only design was conducted in the ICU of Prof. Dr. Chairuddin P. Lubis University Hospital (September 2024). Thirty-two patients underwent purposive sampling and were allocated to intervention (n=16; 0.12% chlorhexidine oral care every shift for 48 hours) or control (n=16; eucalyptol) groups. VAP risk was measured via Clinical Pulmonary Infection Score (CPIS), with bacterial colonization assessed through sputum/bronchoalveolar lavage cultures. Independent t-tests analyzed differences
(p < 0.05).
Results: The chlorhexidine group had a lower mean CPIS of 2.63 ± 1.31 compared to eucalyptol, which had a mean of 3.25 ± 2.24 (p = 0.032). Acinetobacter baumannii carbapenemase-producers were the most common isolates.
Conclusion: The 0.12% chlorhexidine protocol was better than eucalyptol at reducing VAP risk. It should be regularly used in ICU nursing practice.

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Keywords
ventilator-associated pneumonia oral hygiene protocol chlorhexidine 0.12% intensive care unit nursing intervention
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How to Cite
1.
Ronauli Silaen E, Mahyunita S, Elva M. Development and Implementation of a Chlorhexidine-Based Oral Hygiene Protocol to Prevent Ventilator-Associated Pneumonia in ICU Patients: A Quasi-Experimental Study. Arch Anesth & Crit Care. 2026;.