Effect of Oral Decontamination Using Chlorhexidine or Potassium Permanganate in ICU Patients

Sponsor
King Edward Memorial Hospital (Other)
Overall Status
Completed
CT.gov ID
NCT00610324
Collaborator
(none)
512
1
2
43
11.9

Study Details

Study Description

Brief Summary

Oropharyngeal bacteria play an important role in the pathogenesis of nosocomial pneumonia in critically ill patients. Oral cleansing with chlorhexidine has been shown to decrease incidence of pneumonia in patients undergoing open heart surgery. Its role in critically ill general ICU patients is not yet proven. The present study proposes to study the effectiveness of twice-daily oral cleansing with 0.2% chlorhexidine solution on the incidence of nosocomial pneumonia in ICU patients admitted to a single intensive care unit of an Indian public hospital

Condition or Disease Intervention/Treatment Phase
  • Drug: Chlorhexidine gluconate
  • Drug: Potassium permanganate
Phase 4

Detailed Description

Nosocomial pneumonia is common in intensive care units (ICU) patients and is associated with increase in mortality rates by 24% to 76% in various studies. Interventions that effectively prevent nosocomial pneumonia are strategically important in order to reduce morbidity, mortality and healthcare costs. Colonization of the pharynx has been implicated as the reservoirs for pathogens causing nosocomial pneumonia and interventions like selective digestive decontamination have been tried to control this source of infection. Recently, colonization of the dental plaque by aerobic organisms with subsequent aspiration into the lower respiratory tract has received attention. Previous smaller studies using antiseptic agents to sterilize dental plaques in patients at risk of pneumonia have shown conflicting results. The present study aims to determine whether twice daily oral cleansing with 0.2% chlorhexidine reduces the incidence of nosocomial pneumonia in patients staying in the ICU for >48 hours.

After obtaining informed consent, subjects would be randomized to treatment with either 0.2% chlorhexidine gluconate (CHG) solution or 0.01% potassium permanganate solution (PP) (Control Group), as per the protocol approved by the Institutional Ethics Committee. At baseline, the parameters which would be noted are: age, sex, surgical or non-surgical status, immunosuppression, chronic ailments, smoking and alcohol consumption, Glasgow coma scale score (GCS), laboratory parameters and blood gas analysis. All subjects would be followed up daily and the GCS, presence of nasogastric tube (feeds), endotracheal tube, tracheostomy, ventilator, central venous and urinary catheterization, anti-stress ulcer prophylaxis and prior antibiotic use will be noted. Presence or absence of nosocomial pneumonia would also be noted daily. Lower respiratory secretions would be obtained by the protected non-bronchoscopic mini-BAL technique in order to identify the causative organisms. All the subjects will be followed up daily until discharge from the ICU or death.

Primary outcome variable was the development of nosocomial pneumonia during the ICU stay. Secondary outcome variables were hospital mortality, length of ICU stay.

A total of 506 patients will have to be studied (approximately 253 patients in each treatment group). This study will have a statistical power of 75% to detect a 50% reduction in the incidence of nosocomial pneumonia in the intervention group with a 95% level of confidence assuming that incidence of pneumonia in the control group is 16%.

Study Design

Study Type:
Interventional
Actual Enrollment :
512 participants
Allocation:
Randomized
Intervention Model:
Parallel Assignment
Masking:
None (Open Label)
Primary Purpose:
Prevention
Official Title:
Effect of Oral Decontamination Using Chlorhexidine or Potassium Permanganate in ICU Patients: an Open-Labelled Randomized Controlled Trial
Study Start Date :
May 1, 2004
Actual Primary Completion Date :
Oct 1, 2007
Actual Study Completion Date :
Dec 1, 2007

Arms and Interventions

Arm Intervention/Treatment
Experimental: 1

Twice-daily oropharyngeal cleansing with 0.2% Chlorhexidine gluconate

Drug: Chlorhexidine gluconate
Twice-daily oropharyngeal cleansing with 0.2% Chlorhexidine gluconate

Active Comparator: 2

Twice-daily oropharyngeal cleansing with 0.01% Potassium permanganate

Drug: Potassium permanganate
Twice-daily oropharyngeal cleansing with 0.01% Potassium permanganate

Outcome Measures

Primary Outcome Measures

  1. Development of nosocomial pneumonia [During hospital stay]

Secondary Outcome Measures

  1. In-hospital mortality [During hospital stay]

  2. Length of ICU stay (days) [Till discharge from ICU or death]

Eligibility Criteria

Criteria

Ages Eligible for Study:
13 Years and Older
Sexes Eligible for Study:
All
Accepts Healthy Volunteers:
No
Inclusion Criteria:
  • All patients admitted to the medical intensive care unit and are expected to stay in ICU for > 48 hours
Exclusion Criteria:
  • Pregnant women

  • Patients with nosocomial pneumonia at time of ICU admission

  • Patients with community-acquired pneumonia at time of ICU admission

  • Patients in whom oropharyngeal cleansing is contra-indicated

Contacts and Locations

Locations

Site City State Country Postal Code
1 Medical-Neuro Intensive Care Unit, K E M Hospital, Parel Mumbai Maharashtra India 400012

Sponsors and Collaborators

  • King Edward Memorial Hospital

Investigators

  • Principal Investigator: Dilip R Karnad, MD,FACP,FRCP, Professor of Medicine, K E M Hospital, Parel, Mumbai 400012, India

Study Documents (Full-Text)

None provided.

More Information

Publications

Responsible Party:
, ,
ClinicalTrials.gov Identifier:
NCT00610324
Other Study ID Numbers:
  • DRK-CHEX
First Posted:
Feb 7, 2008
Last Update Posted:
Feb 7, 2008
Last Verified:
Jan 1, 2008

Study Results

No Results Posted as of Feb 7, 2008