Traumatic injury in rural America is a significant cause of morbidity and mortality, and the challenges of a rural trauma system can put patients at unique risk. Prolonged transport times to a trauma center, stopping for care at referring hospitals, and longer exposure to care-associated factors distinguish rural patients from their urban counterparts. Ventilator-associated pneumonia (VAP) is a significant risk in rural patients, increasing hospital stay, healthcare costs, and even mortality in the critically injured. The investigators propose a pilot study to test the hypothesis that a single dose of oral chlorhexidine gluconate (antiseptic) for trauma patients in the prehospital environment will decrease subsequent development of early VAP. Chlorhexidine is currently a standard therapy in intensive care units to prevent airway colonization and subsequent development of VAP. Demonstrating safety and effectiveness of prehospital infection control practices could significantly improve outcomes of traumatic injury in rural America.
Study Type
OBSERVATIONAL
Enrollment
70
Study solution will be applied to the oropharynx and will be distributed for 15 seconds with a swab stick. No suction will be applied for at least 30 seconds.
University of Iowa Hospitals and Clinics
Iowa City, Iowa, United States
Clinical Pulmonary Infection Score (CPIS)
Time frame: 48-72 hours
Pneumonia - CPIS
This is the diagnosis of pneumonia within the first 5 days defined by CPIS score \>=6.
Time frame: 5 days
Pneumonia - CDC
This is the diagnosis of pneumonia using CDC criteria within 5 days of admission.
Time frame: 5 days
Pneumonia - Treated
This is the diagnosis of pneumonia defined as antibiotic treatment of suspected pneumonia by the treating clinician.
Time frame: 5 days
Pneumonia - Research
This is the diagnosis of pneumonia within 5 days as adjudicated by 3 clinicians blinded to treatment allocation.
Time frame: 5 days
28-day ventilator-free days
Time frame: 28 days
28-day ICU-free days
Time frame: 28 days
Hospital Mortality
Time frame: 28-days
Tracheostomy Rate
Time frame: 28 days
Tracheal colonization
This analysis will be completed in two ways: the raw analysis will use a chi-squared test to test the null hypothesis that the distribution of semi-quantitative tracheal colonization is the same in the two groups. A second analysis will be performed using the ordinal shift method to compare the change (shift) in the semiquantitative score between admission and 48-72 hours.
Time frame: 48-72 hours
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