***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To document the effect of gingival and dental plaque antiseptic decontamination on the rate of  nosocomial bacteremias and respiratory infections acquired in the intensive care unit ( ICU ) . Design : Prospect i ve , multicenter , double-blind , placebo-controlled efficacy study . Setting : Six ICUs : three in university hospitals and three in general hospitals . Patients : A total of 228 nonedentulous patients requiring endotracheal intubation and mechanical ventilation , with an anticipated length of stay ≥5 days . Interventions : Antiseptic decontamination of gingival and dental plaque with a 0.2 % chlorhexidine gel or a placebo gel , three times a day , during the entire ICU stay . Measurements and Main Results : Demographic and clinical characteristics , organ function data ( Logistic Organ Dysfunction score ) , severity of condition ( Simplified Acute Physiologic Score ) , and dental plaque status were assessed at baseline and until 28 days . Bacteriologic sampling of dental plaque and saliva was done every 5 days , and blood , tracheal aspirate , and bronchoalveolar lavage cultures were performed when appropriate . The primary efficacy end point was the incidence of bacteremia , bronchitis , and ventilator-associated pneumonia , expressed as a percentage and per 1000 ICU days . All baseline characteristics were similar between the treated and the placebo groups . The incidence of nosocomial infections was 17.5 % ( 13.2 per 1000 ICU days ) in the placebo group and 18.4 % ( 13.3 per 1000 ICU days ) in the plaque antiseptic decontamination group ( not significant ) . No difference was observed in the incidence of ventilator-associated pneumonia per ventilator or intubation days , mortality , length of stay , and care loads ( secondary end points ) . On day 10 , the number of positive dental plaque cultures was significantly lower in the treated group ( 29 % vs. 66 % ; p < .05 ) . Highly resistant Pseudomonas , Acinetobacter , and Enterobacter species identified in late-onset ventilator-associated pneumonia and previously cultured from dental plaque were not eradicated by the antiseptic decontamination . No side effect was reported . Conclusions : Gingival and dental plaque antiseptic decontamination significantly decreased the oropharyngeal colonization by aerobic pathogens in ventilated patients . However , its efficacy was insufficient to reduce the incidence of respiratory infections due to multiresistant bacteria Introduction Dental plaque biofilms are colonized by respiratory pathogens in mechanically-ventilated intensive care unit patients . Thus , improvements in oral hygiene in these patients may prevent ventilator-associated pneumonia . The goal of this study was to determine the minimum frequency ( once or twice a day ) for 0.12 % chlorhexidine gluconate application necessary to reduce oral colonization by pathogens in 175 intubated patients in a trauma intensive care unit . Methods A r and omized , double-blind , placebo-controlled clinical trial tested oral topical 0.12 % chlorhexidine gluconate or placebo ( vehicle alone ) , applied once or twice a day by staff nurses . Quantitation of colonization of the oral cavity by respiratory pathogens ( teeth/denture/buccal mucosa ) was measured . Results Subjects were recruited from 1 March , 2004 until 30 November , 2007 . While 175 subjects were r and omized , microbiologic baseline data was available for 146 subjects , with 115 subjects having full outcome assessment after at least 48 hours .  Chlorhexidine reduced the number of Staphylococcus aureus , but not the total number of enterics , Pseudomonas or Acinetobacter in the dental plaque of test subjects . A non-significant reduction in pneumonia rate was noted in groups treated with chlorhexidine compared with the placebo group ( OR = 0.54 , 95 % CI : 0.23 to 1.25 , P = 0.15 ) . No evidence for resistance to chlorhexidine was noted , and no adverse events were observed . No differences were noted in microbiologic or clinical outcomes between treatment arms . Conclusions While decontamination of the oral cavity with chlorhexidine did not reduce the total number of potential respiratory pathogens , it did reduce the number of S. aureus in dental plaque of trauma intensive care patients .Trial Registration clinical trials.gov NCT00123123 BACKGROUND Pneumonia is one of the most common nosocomial infections in hospitalized patients . The risk of nosocomial pneumonia increases with age , severity of acute illness and preexisting co-morbid conditions . Ventilator-associated pneumonia ( VAP ) significantly increases morbidity , length of stay , re source utilization and mortality . The purpose of this study was to determine whether adherence to a ventilator weaning protocol ( WP ) and the use of chlorhexidine gluconate ( CH ) oral rinse for oral hygiene would decrease the incidence of VAP in surgical ICU patients . METHODS A prospect i ve study was conducted over a period of 10 months ( October 1998-July 1999 ) in surgical ICU patients requiring mechanical ventilation ( n = 95 ) . During the first 5 months , a WP was applied to all patients requiring mechanical ventilation . During the following 5 months , a CH 0.12 % oral rinse administered twice daily was added to the protocol , initiated on ICU admission in all intubated patients . The data collection included age , gender , race , risk factors , co-morbid conditions , severity of the acute illness ( APACHE II ) at admission , duration of ventilation , ICU and total-hospital length of stay , and incidence of VAP and in-hospital mortality rates . Both WP and WP+CH groups were compared using the National Nosocomial Infection Surveillance ( NNIS ) and hospital data bases as historic controls . RESULTS The institution of the WP alone led only to a slight decrease in the incidence of VAP but a significant reduction in the median duration of mechanical ventilation by 40 % ( 4.5 days , p < 0.008 ) . The addition of CH to the WP led to a significant reduction and delay in the occurrence of VAP ( 37 % overall , 75 % for late VAP , p < 0.05 ) . The median duration of mechanical ventilation in this group was similar to that of the WP group . There was no significant difference in the overall hospital or ICU length of stay between the groups . CONCLUSIONS Improved oral hygiene via topical CH application in conjunction with the use of a WP is effective in reducing the incidence of VAP and the duration of mechanical ventilation in surgical ICU patients Abstract Objectives : To document in intensive care unit ( ICU ) patients the effect of dental plaque antiseptic decontamination on the occurrence of plaque colonization by aerobic nosocomial pathogens and nosocomial infections . Design : Single-blind r and omized comparative study . Setting : A 16-bed adult intensive care unit in a university hospital . Patients : Patients consecutively admitted in the ICU with a medical condition suggesting an ICU stay of 5 days and requiring mechanical ventilation . Interventions : After r and omization , the treated group received dental plaque decontamination with 0.2 % chlorhexidine gel , three times a day during the ICU stay . The control group received st and ard oral care . Specific measurements : Dental status was assessed by the Caries-Absent-Occluded index ; the amount of dental plaque was assessed by a semi-quantitative plaque index . Bacterial sampling of dental plaque , nasal and tracheal aspirate , blood , and urine cultures were done on days 0 , 5 , 10 , and every week . Main results : Sixty patients were included ; 30 in the treated group and 30 in the control one ( mean age : 51±16 years ; mean Simplified Acute Physiological Score II : 35±14 points ) . On admission , no significant differences were found between both groups for all clinical and dental data . Compared with the control group , the nosocomial infection rate and the incidence densities related to risk exposition were significantly lower in the treated group ( 18 vs 33‰ days in the ICU and 10.7 vs 32.3‰ days of mechanical ventilation ; P<0.05 ) . These results were consistent with a significant preventive effect of the antiseptic decontamination ( Odds Ratio : 0.27 ; 95 % CI : 0.09 ; 0.80 ) with a 53 % relative risk reduction . There was a trend to a reduction of mortality , length of stay , and duration of mechanical ventilation . Conclusions : An antiseptic decontamination of dental plaque with a 0.2 % chlorhexidine gel decreases dental bacterial colonization , and may reduce the incidence of nosocomial infections in ICU patients su bmi tted to mechanical ventilation BACKGROUND Decreasing the levels of bacteria in the oropharynx should reduce the prevalence of nosocomial pneumonia . OBJECTIVES To test the effectiveness of 0.12 % chlorhexidine gluconate oral rinse in decreasing microbial colonization of the respiratory tract and nosocomial pneumonia in patients undergoing open heart surgery . METHODS A prospect i ve , r and omized , case-controlled clinical trial design was used . Peridex ( 0.12 % chlorhexidine gluconate ) was the experimental drug , and Listerine ( phenolic mixture ) was the control drug . A total of 561 patients undergoing aortocoronary bypass or valve surgery requiring cardiopulmonary bypass were r and omized to an experimental ( n = 270 ) or a control ( n = 291 ) group . Nosocomial pneumonia was diagnosed by using the criteria established by the Centers for Disease Control and Prevention . RESULTS The overall rate of nosocomial pneumonia was reduced by 52 % ( 4/270 vs 9/291 ; P = .21 ) in the Peridex-treated patients . Among patients intubated for more than 24 hours who had cultures that showed microbial growth ( all pneumonias occurred in this group ) , the pneumonia rate was reduced by 58 % ( 4/19 vs 9/18 ; P = .06 ) in patients treated with Peridex . In patients at highest risk for pneumonia ( intubated > 24 hours , with cultures showing the most growth ) , the rate was 71 % lower in the Peridex group than in the Listerine group ( 2/10 vs 7/10 ; P = .02 ) . CONCLUSIONS Although rates of nosocomial pneumonia were lower in patients treated with Peridex than in patients treated with Listerine , the difference was significant only in those patients intubated more than 24 hours who had the highest degree of bacterial colonization RATIONALE Ventilator-associated pneumonia ( VAP ) is the most frequently occurring nosocomial infection associated with increased morbidity and mortality . Although oral decontamination with antibiotics reduces incidences of VAP , it is not recommended because of potential selection of antibiotic-resistant pathogens . We hypothesized that oral decontamination with either chlorhexidine ( CHX , 2 % ) or CHX/colistin ( CHX/COL , 2%/2 % ) would reduce and postpone development of VAP , and oral and endotracheal colonization . OBJECTIVES To determine the effect of oral decontamination with CHX or CHX/COL on VAP incidence and time to development of VAP . METHODS Consecutive patients needing mechanical ventilation for 48 h or more were enrolled in a r and omized , double-blind , placebo-controlled trial with three arms : CHX , CHX/COL , and placebo ( PLAC ) . Trial medication was applied every 6 h into the buccal cavity . Oropharyngeal swabs were obtained daily and quantitatively analyzed for gram-positive and gram-negative microorganisms . Endotracheal colonization was monitored twice weekly . RESULTS Of 385 patients included , 130 received PLAC , 127 CHX and 128 CHX/COL . Baseline characteristics were comparable . The daily risk of VAP was reduced in both treatment groups compared with PLAC : 65 % ( hazard ratio [HR]=0.352 ; 95 % confidence interval [ CI ] , 0.160 , 0 . 791 ; p=0.012 ) for CHX and 55 % ( HR=0.454 ; 95 % CI , 0.224 , 0 . 925 ; p=0.030 ) for CHX/COL . CHX/COL provided significant reduction in oropharyngeal colonization with both gram-negative and gram-positive microorganisms , whereas CHX mostly affected gram-positive microorganisms . Endotracheal colonization was reduced for CHX/COL patients and to a lesser extent for CHX patients . No differences in duration of mechanical ventilation , intensive care unit stay , or intensive care unit survival could be demonstrated . CONCLUSIONS Topical oral decontamination with CHX or CHX/COL reduces the incidence of VAP BACKGROUND Ventilator associated pneumonia remains an important concern in the intensive care unit ( ICU ) . An increasing body of evidence shows that mortality and morbidity can be reduced by implementing a range of preventive strategies , including optimizing oral hygiene . AIM The aim of this feasibility study was to test two oral hygiene strateg 
    Output:
    
Neither antiseptics nor antibiotics affected all-cause mortality , duration of ventilation , or duration of intensive care unit ( ICU ) stay .
CONCLUSION Oral decontamination reduced the incidence of VAP in adults undergoing ventilation , but did not affect all-cause mortality , duration of ventilation , or duration of ICU stay in ventilated patients .