Gargling with Aloe vera extract is effective to prevent the Ventilator-Associated Pneumonia (VAP)

Mita Agustina


Background: Long-term use of a mechanic ventilator may cause Ventilator- Associated Pneumonia (VAP) infection, nosocomial pneumonia that occurs after 48 hours in patients using mechanical ventilation either through the endotracheal tube or the tracheostomy tube. To prevent the occurrence of VAP, antiseptic liquid (mouthwash) such as chlorhexidine 2% maybe recommended. However, gargling using chlorhexidine may also cause allergies, thus, Aloe vera extract could be an alternative.

Aims: The purpose of this study was to determine the effectiveness of Aloe vera extract as mouthwash to prevent the occurrence of Ventilator-associated pneumonia.
Methods: This research is a quasi-experiment case-control study with a pre- posttest control group design. The sample size in this study was 30 respondents who were equally distributed into two groups; intervention group was administered using Aloe vera extract, while chlorhexidine was practiced for the control group. To determine the occurrence of VAP, Clinical Pulmonary Infection Score (CPIS) for Ventilator-Associated Pneumonia was measured on the first day of intubation and the fourth day, enumerated by nurses in the emergency room. CPIS is a set of indicators comprised of temperature, leucocyte, trachea secretion, oxygenation (PaO2/FiO in mm Hg), and thorax photo. CPIS value below than five will be regarded non-VAP, while CPIS scored 6-9 will be diagnosed as VAP. Results: Oral hygiene with Aloe vera extract was able to prevent the occurrence of VAP (p-value = 0.001), but there was no significant difference between the control group and intervention in the CPIS component temperature, leukocytes, tracheal secretions, FiO2, and the thoracic component.

Conclusions: Oral hygiene with Aloe vera extract effectively prevented the occurrence of V entilator-Associated Pneumonia (V AP) compared to chlorhexidine. 

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Iwan Purnawan S. Mengelola Pasien Dengan Ventilator Mekanik. 1 ed. Bogor: Rekatama; 2010.

Smeltzer SCB, B.G. Buku Ajar Keperawatan Medikal Bedah. 8 ed. Jakarta: EGC; 2001.

Saragih RJ, Amin Z, Sedono R, Pitoyo CW, Rumende CM. Prediktor mortalitas pasien dengan ventilator-associated pneumonia di RS Cipto Mangunkusumo. eJournal Kedokteran Indonesia. 2014.

Tohirin A. Pengaruh Oral Hygiene Menggunakan Hexadol Gargle Dalam Meminimalkan Kejadian VAP di ICU RSUD Tugurejo:; 2016.

Augustyn B. V entilator-associated pneumonia risk factors and prevention. Critical care nurse. 2007;27(4):32-9.

Rahmawati FA, Leksana E. Angka kejadian pneumonia pada pasien sepsis di ICU RSUP Dr. Kariadi Semarang (The incidence of Pneumonia on patients with sepsis at ICU RSUP Dr. Kariadi Semarang). JURNAL KEDOKTERAN DIPONEGORO. 2014;3(1).

CM R. Pola Resistensi Kuman Penyebab VAP di RSCM tahun 2006-2007. Jakarta: Universitas Indonesia; 2008.

Lev A, Aied AS, Arshed S. The effect of different oral hygiene treatments on the occurrence of ventilator associated pneumonia (VAP) in ventilated patients. Journal of Infection Prevention. 2015;16(2):76-81.

Japoni A, Vazin A, Davarpanah MA, Ardakani MA, Alborzi A, Japoni S, et al. Ventilator-associated pneumonia in Iranian intensive care units. The Journal of Infection in Developing Countries. 2011;5(04):286-93.

Majidah D. Daya antibakteri ekstrak daun seledri (Apium graveolens l.) terhadap pertumbuhan Streptococcus mutans sebagai alternatif obat kumur. 2014.

Puspita K. Pengaruh chlorhexidine gluconate 0,12% terhadap kejadian VAP (The effect of chlorhexidine gluconate 0.12% on VAP incidence). Tidak Diterbitkan Skripsi Denpasar: Fakultas Kedokteran gigi Universitas Mahasaraswati Denpasar. 2014.

Kayum NA. The Comparison of Effectivity between Red Ginger (Zingiber officinale var rubrum) and Aloe Vera Mouthwash Formulae in the Growth of Staphylococcus aureus. Padang: Universitas Andalas Padang; 2015.

Kowalak JP, Welsh W, Mayer B. Buku ajar patofisiologi. Jakarta: EGC. 2011.

Indonesia PDP. Penyakit Paru Obstruktif Kronik Pedoman Diagnosis dan Penatalaksanaan di Indonesia. Jurnal Jakarta. 2003.

Maria E, Permanasari VY, editors. The implementation of Ventilator-Associated Pneumonia bundle (VAP) in the ICU of Eka Hospital, Pekanbaru. Proceedings of the International Conference on Applied Science and Health; 2018.

Dunham CM, Chirichella TJ. Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients. Lipids in health and disease. 2011;10(1):42.

Nair GR, Naidu GS, Jain S, Nagi R, Makkad RS, Jha A. Clinical Effectiveness of Aloe Vera in the Management of Oral Mucosal Diseases- A Systematic Review. Journal of Clinical & Diagnostic Research. 2016;10(8):1-7.

Hutchins K, Karras G, Erwin J, Sullivan KL. Ventilator-associated pneumonia and oral care: a successful quality improvement project. American journal of infection control. 2009;37(7):590-7.

Jain S, Rathod N, Nagi R, Sur J, Laheji A, Gupta N, et al. Antibacterial Effect of Aloe Vera Gel against Oral Pathogens: An In-vitro Study. Journal of Clinical & Diagnostic Research. 2016;10(11):41-4.

Food U, Administration D. FDA Drug Safety Communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. 2017.


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