The Effect of Zufa Versus Chlorhexidine Gluconate Mouthwashes on Oral Flora of Patients Under Mechanical Ventilation in the Intensive Care Unit: A Double-Blind, Randomized Clinical Trial

Background: Aromatic herbs and spices contain essential oils and are recognized by their considerable antimicrobial activity. One of the natural mouthwashes in traditional Iranian medicine is Zufa. It is not clear, however, that the extract of Zufa can affect oral health as much as Chlorhexidine gluconate, which is a potent antimicrobial mouthwash. Objectives: This study aimed to compare the effect of Zufa and Chlorhexidine gluconate mouthwashes on oral flora of patients under mechanical ventilation in ICUs. Methods: This double-blind, randomized clinical trial was conducted on the ninety-ICU-patients receiving mechanical ventilation in a university-affiliated hospital in Sari, Iran, from June 2017 to March 2018. The patients were randomly divided into three groups (n = 30) using block randomization method; the Zufa, Chlorhexidine gluconate, and normal saline groups; the patients’ mouth were washed with 15 mL of the Zufa 0.02%, Chlorhexidine gluconate 2%, or normal saline 0.09%, 30 seconds, twice a day (eight am and four pm), for 3 days, respectively. Oral hygiene status was evaluated before the intervention, and then up to three days after that by the Beck oral assessment scales (BOAS). Results: The data of BOAS showed no significant difference between the Zufa, Chlorhexidine gluconate, and normal saline groups before the intervention phase (P > 0.05), and in this phase BOAS means in the Zufa, Chlorhexidine gluconate, and normal saline were 6.040.56, 6.043.72, and 6.470.62, respectively. A significant association was found between the BOAS score after mouthwashes and the oral health of the patients in the three groups (P > 0.05). Conclusions: Based on the results of our study, mouthwashes of Zufa and normal saline showed the same effectiveness as Chlorhexidine gluconate on the oral health of intubated patients hospitalized in the ICU.