Pneumonia prophylaxis

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• Nosocomial infections
• Ventilator-associated pneumonia (VAP)
• Antiseptic mouth rinsing solution octenident^® antiseptic

Hospital-acquired infections, i.e. nosocomial infections, are among the most common complications of medical treatment.¹ This not only poses a risk to patients, but also places a considerable burden on the healthcare system: around 8.9 million people across Europe contract nosocomial infections every year.² In Germany, the figure is 400,000 to 600,000 patients with up to 20,000 deaths.³ Yet up to half of all nosocomial infections could be avoided through better hygiene measures.^4,5,6 The World Health Organization (WHO) estimates the annual costs for Europe at around seven billion euros.⁷

In addition to avoidable deaths, nosocomial infections exacerbate the development of resistance to antibiotics and sometimes have long-term consequences, including disability or incapacity to work.¹ Post-operative wound infections, urinary tract infections and pneumonia, for example, pose major challenges.⁸

Pneumonia (lung inflammation) is an inflammation of the alveoli and/or interstitial lung tissue.^9,10 It can be acute or chronic.⁹ Among other things, it can occur when people are unable to brush their teeth and bacteria increasingly colonize their teeth, gums and oral cavity. These sometimes enter the respiratory tract through microaspiration, where they can in turn trigger pneumonia. The spectrum of pathogens depends on the age group and cause of infection - bacteria are the most common triggers, but viruses or fungi are less common¹¹.

Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections.¹² A pneumonia is considered ventilator-associated if it occurs at least 48 hours after endotracheal intubation.¹³ Patients in intensive care units have an increased risk of VAP because their oral flora changes to primarily Gram-negative organisms.¹⁴ Gram-negative bacteria are usually the trigger for pneumonia.⁸

Why suitable VAP prophylaxis is of great importance:

• 9 to 25 percent of intensive care patients are affected¹⁵
• Prolongation of hospital stay by around 6 to 9 days^{16, 17}
• Additional costs of up to €30,000 per patient^{18,19,20,21,22}
• Mortality: 9 to 13 percent²³

Endotracheal intubation is considered the main risk factor for VAP.²⁴ The risk of VAP is 21 times higher in intubated patients than in non-intubated patients.²⁵ Common causes of ventilator-associated infections are:

• Colonization of the dental plaque with germs
• Bacterial infestation of the oropharyngeal area (mouth/throat)
• Inhalation of contaminated secretions from the oropharyngeal area

During intubation, the defense mechanisms of the airways are disrupted and expectoration and mucociliary clearance are impeded.²⁴ Microaspiration of bacterial secretions that collect above the inflated blockage of the tube is facilitated and enables the formation of bacterial biofilms.²⁴

If the incidence of pneumonia is to be reduced, adherence to effective infection prevention strategies is essential. Antiseptic oral care is an important component of this, because without it, unwanted microorganisms continue to spread.¹³ Measures that prevent microaspirations are therefore suitable for VAP prophylaxis. In its guideline "Prevention of nosocomial ventilator-associated pneumonia", the KRINKO recommends a bundle of four different measures that should be observed:¹³

• basic (basic measures): Essential infection prevention is achieved through hand hygiene, sufficient staff, staff training, surveillance and wearing work clothes in intensive care units.
  technical-apparatus: This includes changing ventilation tubes no more frequently than every seven days and active and passive respiratory gas humidification.
• Pharmacological: In this area, selective bowel decontamination (SDD) or selective oral decontamination (SOD), for example, can contribute to infection prevention.
• patient-related: This includes positioning measures, enteral nutrition and hygienic oral care.

The oral antiseptic octenident^® antiseptic reaches areas of the teeth, gums and tongue that are difficult to access. This makes it an effective alternative when when mechanical tooth cleaning is not possible or possible. The antiseptic mouth rinse is used to

• temporarily reduce the number of germs in the oral cavity
• temporary inhibition of plaque formation

and can therefore contribute to VAP prophylaxis, as described in the KRINKO guideline "Prevention of nosocomial ventilator-associated pneumonia".

* The effect is rapid: Bactericidal after 30 seconds and levurocidal after 60 seconds (levurocidal efficacy proven in vitro).
** Observe the technical information.