In-Vivo Antimicrobial Efficacy of Three Mouthwashes for Hospital Oral Care
Objectives: Maintaining a low level of oral microbial load through managed oral care is recognized as effective for preventing non-ventilator hospital-acquired pneumonia(NV-HAP) in hospitalized patients. The present study aimed to assess in-vivo antimicrobial activity of three commercial mouthwashes used for hospital oral care.
Methods: Eleven volunteers, with healthy oral status, used one of the followings; GUM® Oral Rinse, LISTERINE® Coolmint® Zero Alcohol Mouthwash, SAGE® Corinz® Antiseptic Cleansing & Moisturizing Oral Rinse or water as Control once daily during the study. Washout periods of minimally 3 days were allowed between study days. The levels of anaerobic salivary bacterial counts were measured at baseline, 30minutes, 1h, 2h and 3h after rinsing. Statistical analysis was conducted on bacterial counts(Log CFU/ml) using linear mixed effect model for association between time and treatment groups, paired t-test for within treatment comparisons, and ANCOVA and Tukey’s test for between treatment comparisons.
Results: No significant difference was detected at baseline with bacteria counts across four treatment groups(mean±SD, GUM:8.01±0.53, Listerine:8.00±0.67, Sage:7.96±0.57, Control:8.01±0.60). All four groups showed the lowest bacteria counts at 30minutes and the counts increased towards the end of duration. Changes were significantly associated with time and treatment groups(p<0.001). At 30minutes, the lowest bacteria count was shown in GUM(7.22±0.72), followed in order by Listerine, Sage and Control(7.46±1.03, 7.67±0.84 and 7.93±0.59, respectively), and all three mouthwashes demonstrated significant reduction from baseline(p<0.05). Only GUM maintained significant inhibition up to 3h(7.71±0.61). Significant difference was observed between GUM and Sage at 30minutes and 3h(p<0.05). The difference between GUM and Listerine was not statistically significant at any time point while a favorable statistical trend towards significance was detected at 3h(p=0.088).
Conclusions: Three commercial mouthwashes exhibited different magnitude and duration of antimicrobial activity in saliva. The results support that only GUM® Oral Rinse has the antimicrobial substantivity for up to 3h.