Effect of oropharyngeal decontamination by topical antibiotics on incidence of ventilator-associated pneumonia in hospitalized traumatic patients in intensive care units

Determination of the effect of oropharyngeal decontamination with local antibiotics on the frequency of ventilator-associated pneumonia in trauma patients in intensive care unit

The study is a double-blind, clinical trial that consists of two groups of intervention and control.Participants will be selected on a 100-person, based on the inclusion and exclusion criteria, and will be assigned to the groups in a simple random manner. participants are selected from hospitalized patients in the intensive care units of Khatam al-Anbia hospital in Zahedan.

In this study, 100 patients were selected from traumatic patients admitted to the intensive care unit of Khatam-ol-Anbia hospital in Zahedan who were eligible and randomly divided into two groups of 50, using colored cards. The person in charge of oral care, department staff, expert researcher and a laboratory associate are not aware of how to drive randomization , solution with volume as much as and looks similar to the drug solution used in the intervention group. The intervention starts from the first day after intubation and lasts for at least 3 and up to 5 days.

Inclusion criteria: Age between 18 and 65 years ; Perform intubation in the first 24 hours and wait at least 72 hours ; Clinical pulmonary infection score less than 6 at the time of arrival; Oral hygiene assessment checklist score 10 or less ; GCS less than 9. Non-compliance criteria: Damage to the mouth, jaw and face; Lack of cancer and diabetes and chronic obstructive pulmonary disease; immunosuppression due to certain medications or diseases; history of broad-based antibiotic therapy in the past 3 months;perform a cardiopulmonary resuscitation process.

The intervention group patients in addition to usual care, including oral care with normal saline four times a day, will be received a pre-compounded solution with 2% concentration of nystatin, poly-myxin and neomycin after washing with normal saline in the oral cavity. The control group is 50 patients. In addition to routine care, normal saline mouthwash four times a day, will be rinsed with a solution that is similar in size and appearance to the intervention, four times a day.

Ventilator associated pneumonia

At first, patients will be selected from eligible people with valid entry criteria and then assigned to two groups of intervention and control in a simple random manner. The randomization will be as follows: 100 cards (corresponding to the estimated sample size) are colored with green and orange colors. Green cards are assigned to the control group and 50 red cards for the intervention group. Cards are arranged randomly. After referring to the department and examining the patient and determining his eligibility, depending on the color of card is assigned to each patient, the control group or intervention is determined.

Only researcher will be aware of the randomness. In order to blindness, a nurse familiar with critical care , after education about the method of mouthwash and the use of tools, recruitment as a partner who is not familiar with how to allocate patients in the intervention or control group. The solution is uniform and looks similar to the drug solution is provided and give to the nurse for the control group. Proficient collaborator and Samples analyzer lab will not be aware of the randomness.