Anggi Adhela 1714201110068 (7B) Kep. Kritis

TUGAS ANALISA JURNAL
KEPERAWATAN KRITIS
Dosen pengampu: Julianto, Ns.,M.Kep
DI SUSUN OLEH
Nama : Anggi Adhela
NPM :1714201110068
PROGRAM STUDI S1 KEPERAWATAN

FAKULTAS KEPERAWATAN ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH BANJARMASIN
2020
ANALISIS JURNAL
Jurnal Identifikasi 1 2
Judul The Comparison Of The Effect Of Effectiveness Of Suction

Honey And Chlorhexidine In Above Cuff Endotracheal
Preventing Ventilator Associated Tube (SACETT) In
Pneumonia In Patients On Preventing Ventilator
Mechanical Ventilation Associated pneumonia In
Critical Patients In Intensive
Care Unit
Peneliti Syaukia Adini, Bedjo Santoso, Arfiyan Sukmadi, Rr Sri

Sarkum, Sudirman Endang Pujiastuti, Aris
Santjaka, Supriyadi
Nama Jurnal/Vol/No Adini, S., Santoso, B., Sarkum., et Sukmadi, A., et.al Belitung
al. Belitung Nursing Journal. 2018 Journal. 2018 August;4 (4) :
April; 4(2): 161-167 380-389
Tahun Publikasi 2018 2017
Tujuan Penelitian Membandingkan efektivitas madu Membandingkan kombinasi

dan 0,2% chlorhexidine sebagai intubasi menggunakan
solusi kebersihan mulut pada SACETT dan oral hygiene
ventilator terkait pneumonia. menggunakan Chlorhexidine
0,2%
Desain Penelitian Penelitian eksperimen semu Quasi-exsperimental dengan

dengan desain control group posttest only with control
posttest only. group design.
Teknik Sampling Consecutive sampling Purposive sampling
Jumlah Sampling 30 pasien 30 pasien
Waktu Penelitian 24 Januari 2017 – 24 Februari 25 Juni 2017 – 5 November

2017 2017
Hasil Penelitian Dalam studi ini madu dan Peneitian ini

klorheksidin sama-sama mampu menggambarkan bahwa
membunuh gram positif dan tidak ada kejadian VAP
bakteri negative. Dengan pada kelompok intervensi,
demikian, kesua material tersebut dan sebanyak 13,3% VAP
bias digunakan sebagai antiseptic pada kelompok intervensi.
kebersihan mulut untuk mencegah Kelompok control. SACETT
terjadinya VAP pada penderita lebih efektif dalam
ventilator dipasang. mencegah VAP
dibandingkan dengan ETT
standar pada hari ke 4 (p =
0,001).
Kesimpulan Berdasarkan hasil penelitian ini Insiden VAP berdasarkan

dapat dikatakan dapat penilaian CPIS pada hari
menyimpulkan bahwa larutan keempat sebanyak 3,3% di
madu 20% mengandung efek yang penggunaan OSS-ETT.
sama dengan klorheksidin 0,2% Penelitian ini menunjukkan
masuk mencegah VAP, yang bias bahwa kombinasi intubasi
dilihat dari Skor CIPS. Namun, menggunakan SACETT dan
diperlukan studi lebih lanjut untuk oral hygiene menggunakan
menambahkan jumlah hari Chlorhexidine 0,2%
observasi sampai pasien tidak lagi sebanyak dua kali harian
menggunakan ventilator atau lebih efektif daripada ETT
diekstubasi. Inspeksi budaya juga standar intubasi dengan
diperlukan untuk melihat jumlah system hisap terbuka dalam
bakteri terkait VAP. mencegah VAP, dengan p-
value = 0,001. Itu
penggunaan SACETT dan
kebersihan mulut
menggunakan klorheksidine
0,2% terbukti mencegah
VAP masuk pasien <60
tahun dan dengan indikasi
intubasi pada penyakit
system kardiovaskular,
system saraf, system
kekebalan ,system kemih
dan system pencernaan.
Oleh karena itu, di
pencegahan VAP pada
pasien kritis itu disarankan
untuk menggabungkan
SACETT dan oral
kebersihan dengan
Chlorhexidine 0,2%
Adini, S., Santoso, B., Sarkum., et al. Belitung Nursing Journal. 2018 April;4(2):161-167
Received: 5 February 2018 | Accepted: 20 March 2018
http://belitungraya.org/BRP/index.php/bnj/
© 2018 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License which permits
unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ORIGINAL RESEARCH ISSN: 2477-4073
THE COMPARISON OF THE EFFECT OF HONEY AND

CHLORHEXIDINE IN PREVENTING VENTILATOR ASSOCIATED
PNEUMONIA IN PATIENTS ON MECHANICAL VENTILATON
Syaukia Adini*, Bedjo Santoso, Sarkum, Sudirman
Program Pascasarjana Magister Terapan Kesehatan Keperawatan, Poltekkes Kemenkes Semarang, Indonesia
*Corresponding author:
Syaukia Adini
Program Pascasarjana Magister Terapan Kesehatan Keperawatan
Poltekkes Kemenkes Semarang
Jl. Tirto Agung, Pedalangan, Banyumanik, Kota Semarang, Jawa Tengah, Indonesia (50268)
Email: adinisyaukia@gmail.com
Abstract
Background: Ventilator Associated Pneumonia (VAP) is one of the causes of infection in the hospital and the main cause
of death due to nosocomial infection. The strategy to prevent VAP is by oral hygiene. Honey may be a good solution for
oral hygiene.
Objective: This study aims to compare the effect of the use of 20% honey solution and 0.2% chlorhexidine as oral
hygiene on VAP prevention in patients on mechanical ventilation.
Methods: This was a quasi-experimental study with posttest only control group design in an incentive care unit of a
general hospital in Indonesia. Thirty respondents were selected using consecutive sampling, which 15 respondents
assigned in a 20% honey group and 0.2% chlorhexidine group. Clinical Pulmonary Infection Score (CPIS) was used to
measure Ventilator Associated Pneumonia. Data were analyzed using Independent t-test.
Results: The mean of CPIS in the honey group was 3.33 and the chlorhexidine group was 3.53. Independent t-test showed
p-value 0.618 (>0.05), which indicated that there was no significant difference of the effect of honey and chlorhexidine on
VAP event.
Conclusion: The 20% honey solution has the same effect with 0.2% chlorhexidine in preventing VAP events in patients
on mechanical ventilation.
Keywords: 0.2% chlorhexidine; CPIS; honey; oral hygiene; VAP; ventilator
INTRODUCTION
The mechanical ventilator is a substitute for Fontaine, Hudak, & Gallo, 2013;
ventilation function for patients with Sundana,
indications of respiratory and other critical
illnesses. However, the use of mechanical 2014).
ventilators may lead to various complications
in respiratory, cardiovascular, central nervous
system, gastrointestinal, psychological and Infection due to ventilator or known as
oral health. Endotracheal and oropharyngeal Ventilator Associated Pneumonia (VAP) is
tubes of critical patients with intubation can the second cause of infection in the hospital
be a vector for the migration of pathogenic and the main cause of death due to
germs to allow for infection (Morton, nosocomial infection. Patients suffering from
high-risk critical disease may experience
pneumonia due to ventilator, which is defined
as nosocomial pneumonia in patients who
Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018
161
Editor’s Note: This article has been updated on 30 June 2020 in terms of minor changes in the reference format. The update is according to BNJ Policy on article correction.
Adini, S., Santoso, B., Sarkum., Sudirman. (2018)
have been installed a ventilator for at least 48 diabetes (p = 0.107), and smoking (p = 1.000)
hours at the time of diagnosis. The VAP with the incidence of VAP nosocomial
patients are characterized by chest x-ray infection, only the duration of ventilator use
results suggesting a new (progressive) (p = 0.000) has a significant correlation with
infiltration or sedentary infiltration including VAP infection (Lorente, Lecuona, Jiménez,
other symptoms such as high fever over 380C, Mora, & Sierra, 2007).
leukocytosis, new onset of purulent sputum
and cough, and a worsening gas trade
(Vanhems et al., 2011). VAP can be prevented by various strategies,
including basic nursing principles such as
hand washing, wearing gloves when
The long-term use of mechanical ventilators is performing nursing procedures, oral hygiene
assumed to be one of the important risk
factors associated with VAP events. In 2001-
2009, in the 11 intensive care units in the

hospitals in France found 10.8% of 3,387
patients experienced VAP in the first 9 days
calculated in 45.760 days. The prediction of
the VAP incidence in the first and second day
(<48 hours) is 5.3 and 8.3 events. The study is
performed on patients with an average age of
54.3 years with mortality rate of 21.7%

(Fatmawati R, 2014).
The VAP incidence rates in Indonesia itself

vary. Data at the General Hospital Center in
Jakarta area found that there is an increasing
trend, which the highest incidence occurred
on July 2014 (21.2%) and the lowest on
September 2014 (5.53%) (Rosyida, 2011). In
the General Hospital of Margono in 2015, the
incidence of pneumonia was about 15%
(RSUD Margono, 2015).
There have been several risk factors related to

VAP incidence such as suction method, age,
history of lung disease, diabetes mellitus and
smoking, including duration of ventilator use;
while study found no significant relationship
between age (p = 0.230) suction (p = 0.149),
history of lung disease (p = 0.469), history of
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using an antiseptic solution and mouthwash, 2017 to 24 February 2017 in the Incentive
applying a mouth moisturizer, and sucking Care Unit of the General Hospital of Prof. Dr.
and cleaning the secret (Vanhems et al., Margono Soekadjo, Central Java, Indonesia.
2011).
Research subjects
The antiseptic used to clean the mouth such as Thirty respondents were selected using
chlorhexidine. Study states that oral care with consecutive sampling, which 15 respondents
chlorhexidine reduced the risk of VAP assigned in a 20% honey group and 0.2%
development with p value = 0.03. Another chlorhexidine group. The inclusion criteria of
study compared the effect of hexadol and the sample were patients with ventilator and
chlorhexidine resulted in 1 person (3.33%) endotracheal tube intubation (ETT) on the
exposed VAP in both chlorhexidine and first day, patients who used ventilator for up
hexadol treatment group.
Several studies have shown that antiseptics

for oral hygiene can use honey. Study reveals
there is a significant difference in the
proportion of stomatitis stages before and
after oral hygiene with honey (p = 0.000) and
0.12% chlorhexidine (p = 0.005). The use of

honey as a solution for oral hygiene in
children with stomatitis can decrease
stomatitis stages by 75%, with 21%
differences with those who did not get honey
(Nurhidayatun, Allenidekania, & E, 2016).
The purpose of this study was to compare the
effectiveness of honey and 0.2%
chlorhexidine as a solution for oral hygiene on
ventilator associated pneumonia.
METHODS
Study design
This study was a quasi-experimental study

with posttest only control group design.
Setting
The study was conducted from 24 January

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3
to 4 days of treatment, and no previous signs and no ARDS), thorax photo (score 0 if no
of infection such as temperature (i.e. >380C). infiltrate; score 1 if diffuse infiltrate; and
The exclusion criteria were patients with HIV score 2 if localized infiltrate). All scores are
and tracheostomy.
summed, if the score of CPIS is 0-5 then no
VAP, and if CPIS score is ≥6-9, then VAP
occurs.
Intervention
Oral hygiene performed in both honey and

chlorhexidine group was based on the same While the criteria of oral hygiene were oral
Standard of Operating Procedure in the mucosa and tongue is pink, moist, wet gums,
hospital. The only difference was the solution teeth look clean, and slippery, pink is tongue
used. For the experiment group, oral hygiene
used 20% honey produced by Perhutani
company that has been standardized by
Indonesia , while the control group used 0.2%
chlorhexidine. The intervention was
conducted by researchers and assisted by four
research assistants. Oral hygiene was
performed twice daily in every morning and
afternoon from the 1st day of using ventilator
until the 4th day.
Instrument
Clinical Pulmonary Infection Score (CPIS)

(Hamid, Pujiastuti, Widigdo, & Saha, 2018)
was used to measure Ventilator Associated
Pneumonia (VAP) including: body
temperature (°C) (score 0 if temperature
≥36.5 and ≤38.4; score 1 if temperature ≥38.4

and ≤38.9; score 2 if temperature ≥39.0 and
≤36.0), leukocytes (per mm3) (score 0 if ≥
4,000 and ≤11,000; score 1 if <4000 and
>11,000), tracheal secretions (score 0 if no or
few secrets; score 1 if having secrets and no

purulent; and score 2 if having secrets and
purulent), oxygenation (score 0 if PaO2/FiO2
>240 or ARDS; score 2 if PaO2/FiO2 ≤240
16
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and not dirty, moist, mucosa and pharynx Table 3 shows there was no VAP event in
remain clean. both honey and chlorhexidine group. And
Table 4 shows that the mean of CPIS in the
honey group was 3.33 and the chlorhexidine
Ethical consideration group was 3.53. Independent t-test showed p-
value 0.618 (>0.05), which indicated that
This study has been approved by the Ethical
there was no significant difference of the
Research Committee of Poltekkes Semarang effect of honey and chlorhexidine on VAP
with approval number: 286/KEPK/Poltekkes- event.
Smg/EC/2016
Statistical analysis
The statistical analysis was performed using

SPSS version 18.0. The respondents’
characteristic was described using frequency
and percentage. Independent t-test was used to
compare the results of the effect of honey and
chlorhexidine on VAP with p-value <0.05 and
confidence interval of 95%.
RESULTS
Table 1 shows that the majority of

respondents in the honey and chlorhexidine
group aged 41-60 years. Most of respondents
in the honey group were females (30%) and in
the chlorhexidine group was males (30%).
The type of disease in the chlorhexidine group
was heart disease (13.33%) and in the honey
group was other diseases (13.33%).
Table 2 shows that the majority of

respondents in the honey and chlorhexidine
group had a body temperature ranged 36.5-
38.4, had secrets with no purulent, leucocytes
<4000/>11000, FiO2> 240 / ARDS, and

thorax photo showed diffuse infiltrate.
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Table 1 Characteristics of respondents based on age, gender, and type of disease (n=30)
Oral Hygiene
Honey Chlorhexidine
=15 n=15 p
F % Mean ±SD F % Mean ±SD
Age group 2.67±0.900 2.87±0.915 1.00
21-40 years 3 10 4 13.33

41-60 years 8 26.67 6 20
61-80 years 2 6.67 4 13.33
Gender 1.60±0.507 1.40±0.507 1.00
Male 6 20 9 30
Female 9 30 6 20
Type of disease 4.87±1.807 3.53±2.066 0.56
Respiration 2 6.67 2 6.67
Heart 2 6.67 4 13.33
Nervous 2 6.67 3 10.00
Urination 3 10 2 6.67
Digestion 2 6.67 2 6.67
Others 4 13.33 2 6.67
Table 2 Frequency distribution of respondents based on CPIS (n=30)
Frequency
F %
36.5-38.4 11 36.67
Honey 38.5-38.9 1 3.33 0.47+ 0.834
Body <36.5/>39 3 10.00
temperature 36.5-38.4 10 33.33
Chlorhexidine 38.5-38.9 4 13.33 0.40+ 0.632
<36.5/>39 1 3.33
No secret 0 0
Honey Yes, but not purulent 11 36.67 1.27+ 0.458
Yes, purulent 4 13.33

Secrets
No secret 1 3.33
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Chlorhexidine Yes, but not purulent 9 30.00 1.27+ 0.594
Yes, purulent 5 16.67
4000-11000 5 16.67
Honey 0.67+ 0.488
<4000/>11000 10 33.33
Leucocytes
Chlorhexidine 0.60+ 0.507
Honey 0.27+ 0.704

4000-11000 6 20.00
FiO2
> 240 / ARDS 13 43.33
Chlorhexidine
< 240 / no ARDS 2 36.67 0.53+ 0.915
< 240 / no ARDS 4 13.33
No infiltrate 5 16.67
Honey Diffuse infiltrate 10 33.33 0.67+ 0.488
Thorax Localized infiltrate 0 0.00
photo No infiltrate 4 13.33
Chlorhexidine Diffuse infiltrate 11 36.67 0.73+ 0.421
Localized infiltrate 0 0.00
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Table 3 Frequency distribution of respondents based on VAP event (n=30)
Oral Hygiene
Honey Chlorhexidine Total
n=15 n=15 n=30
F % F % N %
VAP 0 0 0 0 0 0
VAP
No VAP 15 50 15 50 30 100
Table 4 Effect of honey and chlorhexidine on VAP using Independent t-test (n=30)
Group
Honey Chlorhexidine T p
Variable Mean + SD Mean + SD
CPIS 3.33 ± 0.976 3.53± 1.187 0.504 0.618
DISCUSSION <60 years or >60 years is equally at risk of
VAP.
The characteristics of respondents aged

ranging from 41-60 years with the number of
The results of this study also found that the
14 respondents (46.7%). It is line with the gender of respondents was equal between men
literature states that some adults are and women (50%). It is different from the
susceptible to respiratory system disorders, other study mentioned more men than women
decreased neurological conditions, acute renal with VAP. On the other hand, majority of the
failure, shock, and metabolic syndrome respondents with VAP had a type of disease
(Hunter, 2006). The other studies state that related to cardiovascular system, which is
age over 60 or between 54-79 years is more similar with previous study (Sundana, 2014).
susceptible to VAP events (Saragih, Amin,
Sedono, Pitoyo, & Rumende, 2014). This is
associated with the frequency of adult patients Some of the nosocomial pneumonia occurs
who enter ICU because of respiratory system after surgery, especially if mechanical
disorder and requiring the assistance of a ventilation is necessary. Patients with
mechanical ventilator. It can be said that age
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ventilators have 6-12 times higher in the risk

of nosocomial pneumonia than non-
ventilators patients. The main reason for the
use of mechanical ventilator in surgical
patients is the type of surgery, while in
medical patients the use of ventilator is
usually associated with a patient's illness,
which is the risk of bacterial nosocomial
pneumonia following cardiac and pulmonary
surgery (e.g. bypass surgery and lung
resection) is 38 times greater than other
surgeries (Huraini, 2011).
The process of entry of bacteria in patients

with ventilator is when endotracheal tube is
attached to the patient. The size of ETT
attached to the patient is one third of the
respiratory tract, so it is possible for bacteria
to enter the open breathing hole. Thus, to
avoid it, oral hygiene is needed to minimize
the incident of VAP. In this study, there was
no significant difference between the effect of
20% honey solution and 0.2% chlorhexidine
as oral hygiene on ventilator associated

pneumonia in patients with mechanical
ventilator seen from the component on
Clinical Pulmonary Infection Score with p =
0.618 (> 0.05). Thus, it could be said that
20% honey solution and 0.2% chlorhexidine

are equally good in VAP prevention. Studies
have shown that honey has a function as an
anti-bacterial, but it can also be antifungal and
16
9
antivirus. Honey is able to not only inhibit the ± 76.625 with p-value = 0.000 (Mandell et al.,
growth of rubella virus, herpes virus and three
species of leishmania parasite, but also inhibit 2007). Another study showed that there was a
the growth of dermatophyte fungi, candida significant difference in the number of
albicans, C krusei, C tricosporon and C colonies of oral bacterial growth between
glabrata that often attack humans (Huraini, before and after rinse with chlorhexidine with
p-value <0.05 (Patabnag, 2016). In this study
2011). both honey and chlorhexidine are equally
capable of killing both gram positive and
negative bacteria. Thus, both materials can be
The other study revealed that honey in the used as an oral hygiene antiseptic to prevent
concentration of 100%, 75%, 50%, and 25%
are able to inhibit the growth of bacteria, both
gram positive and negative bacteria. The
antibacterial activity of honey is dominated by
hydrogen peroxide, When the damaged
system releases a small amount of glucose and
produce gluconic acid and hydrogen peroxide,
the honey is then analyzed to have a low pH
that may have contributed to their
antibacterial activity, because low pH honey
inhibits the presence and growth of
microorganisms (Krishnasree & Ukkuru,
2015).
On the other hand, studies state that

chlorhexidine has the ability to inhibit the
formation of biofilms, a germicidal
mechanism to invade the host body (Mandell
et al., 2007). Oral care treatment with
chlorhexidine reduces the risk of VAP
(p=0.03). Supported by the other study said
that the effect of chlorhexidine and hexadol is
equal for VAP prevention (Tan, Banzon,
Ayuyao, & de Guia, 2007).
Statistical analysis revealed that chlorhexidine

was effective in preventing VAP seen from
CPIS score. This is in line with previous study
stated that there was a significant effect of
chlorhexidine in decreasing the number of
oropharyngeal bacteria from 300 ± 0.0 to 160
17
0
the occurrence of VAP in patients with Postgraduate Medical Journal, 82(965), 172-
ventilator installed.
178.
Huraini, E. (2011). Pengaruh mobilisasi dan fisioterapi

dada terhadap kejadian ventilator associated
pneumonia di unit perawatan intensif [Effect
of mobilization and chest physiotherapy on
ventialtor associated pneumonia in the
CONCLUSION intensive care unit]. NERS Jurnal
Keperawatan, 7(2), 121-129.
Krishnasree, V., & Ukkuru, P. M. (2015). Antibacterial

activity of honeys produced by five major bee
Based on the results of this study, it can be species in Kerala. International Journal of
concluded that 20% honey solution has the Applied and Pure Science and Agriculture,
same effect with 0.2% chlorhexidine in 1(3), 39-45.
preventing VAP, which can be seen from
CIPS score. However, further study is needed Lorente, L., Lecuona, M., Jiménez, A., Mora, M. L., &
Sierra, A. (2007). Influence of an endotracheal
to add the number of days for observation tube with polyurethane cuff and subglottic
until the patients no longer use ventilator or
extubated. Culture inspection is also
necessary to accurately see the number of
bacteria related VAP.
Declaration of Conflicting Interest
None declared.
Funding
This study was supported by Program Pascasarjana
Magister Terapan Kesehatan Keperawatan, Poltekkes
Kemenkes Semarang, Indonesia.
Author Contribution
All authors contributed equally in this study.
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Cite this article as: Adini, S., Santoso, B., Sarkum., Sudirman. (2018). The comparison of the effect of honey and
chlorhexidine in preventing ventilator associated pneumonia in patients on mechanical ventilation. Belitung Nursing
Journal,4(2),161-167. https://doi.org/10.33546/bnj.355
Sukmadi, A., et al. Belitung Nursing Journal. 2018 August;4(4):380-389
17
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Received: 25 June 2017 | Accepted: 5 November 2017

http://belitungraya.org/BRP/index.php/bnj/
© 2018 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License which permits
unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
ORIGINAL RESEARCH ISSN: 2477-4073
EFFECTIVENESS OF SUCTION ABOVE CUFF ENDOTRACHEAL

TUBE (SACETT) IN PREVENTING VENTILATOR ASSOCIATED
PNEUMONIA IN CRITICAL PATIENTS IN INTENSIVE CARE UNIT
Arfiyan Sukmadi1, Rr Sri Endang Pujiastuti2, Aris Santjaka2, Supriyadi2
1
Program Pascasarjana, Magister Terapan Kesehatan, Politeknik Kesehatan Kemenkes Semarang, Indonesia
2
Politeknik Kesehatan Kemenkes Semarang, Indonesia
*Corresponding author:
Arfiyan Sukmadi
Program Pascasarjana, Magister Terapan Kesehatan,

Politeknik Kesehatan Kemenkes Semarang
Kampus Pusat Jl. Tirto Agung Pedalangan, Banyumanik Semarang 50237, Jawa Tengah, Indonesia.
E-mail : yan.arfiyan@gmail.com
Abstract
Background: The mechanical ventilator is an indispensable breathing tool in the Intensive Care Unit (ICU). But the
mechanical ventilator is associated with the risk of Ventilator Associated Pneumonia (VAP). VAP occurs due to poor
hygiene of the endotracheal tube (ETT). ETT hygiene should be maintained to inhibit bacterial development in the lungs
using suction above cuff endotracheal tube (SACETT) to prevent VAP.
Objective: To analyze the effectiveness of SACETT in preventing Ventilator Associated Pneumonia (VAP) in critical
patients in the ICU.
Methods: This was a quasi-experimental study with posttest only with control group design with 15 samples in intervention
group (SACETT and Chlorhexidine 0.2%) and 15 in control group (ETT, Open Suction, and Chlorhexidine 0.2%) with
purposive technique sampling. The Simplified Clinical Pulmonary Infection Score (CPIS) was used to measure VAP.
Results: This study illustrates that there was no VAP incidence in the intervention group, and as much as 13.3% VAP in the
control group. SACETT was more effective in preventing VAP than in standard ETT on day 4 (p = 0.001).
Conclusion: SACETT is more effective in preventing VAP than standard ETT in the fourth day in patients with
neurological, cardiovascular, urinary, digestive, and immune system disorders.
Keywords: suction above cuff endotracheal tube; standard endotracheal tube; associated pneumonia ventilator; critical
patient
17
4
INTRODUCTION
A mechanical ventilator is an indispensable 48 hours (Patricia, Dorrie, & Barbara, 2012).

respiratory aid in an Intensive Care Unit (ICU) Pneumonia is an infectious disease that occurs
of hospital. However, mechanical ventilation with very high frequency, with the incidence
is also strongly associated with the risk of of 9-24 % after 48 hours from the beginning of
Ventilator Associated Pneumonia (VAP) artificial respiratory management (Chastre &
(Bouza et al., 2001). VAP is one of the causes Fagon, 2002).
of morbidity and mortality in ICU. Pneumonia
due to ventilator use is a nosocomial
pneumonia that is very common in patients The incidence of VAP in the world is quite
who have mechanically ventilated (with high, varying between 9 and 27% and the
endotracheal tube or tracheostomy) for at least mortality rate exceeding 50%. The VAP
problem ranks 2nd as a nosocomial infection
Belitung Nursing Journal, Volume 4, Issue 4, July-August 2018
380
Editor’s Note: This article has been updated on 22 June 2020 in terms of minor changes in the reference format. The update is according to BNJ Policy on article correction.
17
5
Sukmadi, A., Pujiastuti, Rr. S. E., Santjaka, A., Supriyadi. (2018).
in hospitals in the United States. The incidence Installation of ETT into port de entree of
of nosocomial pneumonia ranges from 5 to 10 bacteria directly to the lower respiratory tract
cases per 1000 patients, the incidence rate and trachea. Due to the opening of the upper
increases 6 to 20 times in ventilator-installed respiratory tract, there is a decrease in the
patients, the mortality rate ranges from 20 to ability to filter and warm the air. ETT fixation
may also reduce coughing reflexes and
50% (Perhimpunan Dokter Paru Indonesia, disturbances of the respiratory tract cilium as
2005). Studies on the Global prospective there is mucosal injury during intubation to
epidemiologic and surveillance study of allow bacteria to colonize the trachea
ventilator-associated pneumonia in ICU in 56 (Augustyn, 2007). Prevention of
locations in 11 countries in four regions: The
United States, Europe, Latin America and Asia
Pacific showed a total of 1873 incidents. VAP
incidence in Indonesia based on VAP research
at Cipto Mangunkusumo Hospital has found
27.4% of cases during January 2003 until

December 2012 (Saragih, Amin, Sedono,
Pitoyo, & Rumende, 2014). VAP incidence
data at Fatmawati General Hospital (RSUP)
found that there was an increasing trend, the
highest incidence occurred in July 2014 which
was 21.2 % and the lowest of September 2014
was 5.53 % (RSUP Fatmawati, 2014). While
based on research at Central Hospital Force
Land (RSPAD) Gatot Soebroto, VAP
incidence during the year 2014 as much as
21.8% of patients (Handari, 2015).
VAP occurs due to poor hygiene and duration

of endotracheal tube (ETT). ETT hygiene
should be maintained to inhibit bacterial
development in the lung, bacterial proliferation
is also affected by patient population, length of
treatment, and antibiotics (Saragih et al.,
2014). Patients with VAP have higher

mortality rates, longer stay in ICU and
hospitals, and need more expense for
treatment. Therefore, VAP prevention is
urgently needed and has become a priority in
intensive care research aimed at improving
patient health status by reducing mortality.
38
oropharyngeal or biofilm aspiration in ETT- (medium category) and not specific in the use
attached patients is by using an ETT design of oral hygiene antiseptic (Jena et al., 2016).
different from the standard. Innovation in ETT
design lies in the placement of a hole just
above the cuff balloon, connected to the lumen Oral hygiene as one of the independent
that allows intermittent or continuous sucking measures of nursing services is essential to be
of subglotted secretions known as suction
above cuff endotracheal tube (SACETT)
(Deem & Treggiari, 2010).
The use of standard ETT commonly used in

various hospitals illustrates the condition that
the secretions accumulated in the upper
respiratory tract of the patient are removed by
using a suction tube inserted into the oral
cavity, nasal cavity and / or throat cavity but
not reaching into the area above the balloon
cuff. This allows the contamination of the
suction tube into the respiratory tract, which
increases the risk of infection in the lung so
that it can cause VAP, which can affect the
increasing length of day care and patient care
costs in the ICU room. SACETT aims to clean
up the secretions above the ETT cuff balloon
with the aim of preventing the microbialization
and colonization of pathogenic germs in the
lung where the accumulated secretions are
removed by connecting the vacuum suction
machine with suction cuff to SACETT, so
there is no need to enter the suction tube into
the canal upper respiration with reach to the
area just above the balloon cuff. Thus, the use
of SACETT is expected to minimize the risk
of VAP occurring in the ICU chamber.
A study compared Suction Above Cuff

Endotracheal Tube (SACETT) with standard
ETT in preventing VAP in patients with
neurologic disease ventilator using randomized
controlled pilot study method, conducted in 24
months with 54 respondents in which 4 of
them dropped out and the results found
differences microbiological incidence VAP on
day 5 between the two ETT models in which
SACETT was lower than standard ETT but not
statistically significant with effect size of 0.14
38
carried out routinely in order to maintain the results of the classical CPIS examination
health of the patient's oral cavity and prevent (Balanchivadze, Dy, & Boyce, 2015). This
the risk of lung infection from the upper study aims to reveal the possibility of the
gastrointestinal tract. Chlorhexidine has been influence of the type and design of
widely demonstrated, and used as an effective Endotracheal Tube (ETT): Suction Above
prophylactic antiseptic in preventing the Cuff Endotracheal Tube (SACETT) and
occurrence of VAP in patients with integrated Endotracheal Tube standard (ETT) with Open
intravenous ventilators. Previous study of the Suction System (OSS) and Chlorhexidine
effects of endotracheal tubes with
polyurethane cuff (PUC) and subglottic
secretion drainage (SSD) using open suction
system (OSS) and Chlorhexidine as oral
hygiene in pneumonia found no significant
difference between the two groups studied
(conventional ETT and ETT PUC-SSD) after
day 4, but the incidence of VAP in the PUC-
SSD ETT group was lower than in the
conventional ETT group with an effect size of
0.186 (medium category) (Lorente, Lecuona,
Jiménez, Mora, & Sierra, 2007).
VAP diagnostic examination is done through

Clinical Pulmonary Infection Score (CPIS).
CPIS is most effectively used to identify
patients who require antibiotic therapy,
minimize exposure, and patients who require
treatment therapy longer. The classical CPIS
contains 7 examination variables consisting of
body temperature, leucocytes, tracheal
secretions, PaO2 / FiO2, piston photographs,
and development of pulmonary infiltrate and
culture examination (Luyt, Chastre, Fagon, &
Group, 2004). Previous study modified CPIS
by removing lung infiltrates development
component and culture examination to
minimize unnecessary use of antibiotics but
still providing flexibility in the management of
patients with pneumonia (da Silva, de Aguiar,
& Fonseca, 2014). Another study suggested
that modified CPIS without culture

examination is easier to do in patients with
pneumonia after 72 hours (day 4), which is
modified CPIS has a good correlation with the
38
0.2% as oral hygiene in preventing VAP in malignant disease, patients with HIV / AIDS,
patients installed mechanical ventilator. and patients who are taking a corticosteroid
Instrument
SACETT was attached to patients who met the

METHODS
inclusion criteria for subsequent intervention
groups and OSS-ETT was attached to the
control group, which both of them have oral
Study design hygiene using Chlorhexidine 0.2% twice daily.
VAP examination uses simplified CPIS (body
This was a quasi-experimental study with
posttest only with control group design, which

the cause and effect variable that occurs in the
research object is measured or collected
simultaneously, momentarily or once at one
time (at the same time), and no follow up
(Sastroasmoro & Ismael, 2002). In this study
there are two groups, namely SACETT group
and OSS-ETT group which both groups are
using Chlorhexidine 0.2% as oral hygiene
twice daily.
Sample
Thirty respondents were selected using
purposive sampling, which 15 were assigned

in each group. Determination and division of
SACETT and OSS-ETT groups were based on
ETT installed groove, which respondents
indicated the installation of mechanical
ventilator from Emergency Installation (IGD)
installed standard ETT in IGD (OSS-ETT
group). While the respondent indicated the
installation of mechanical ventilator from the
inpatient room and or ICU installed ETT with
suction above cuff in ICU (SACETT group).
The inclusion criteria of the samples were:
patients with mechanical ventilator and treated
in ICU for at least 72 hours, adult males and
females (> 18 years old), patients with GCS <8
(decreased function of coughing and
swallowing reflexes), patients with body
temperature in the normal range (36.5 -
37.5oC). The exclusion criteria were: patients

with prior history of pneumonia, patients with
38
temperature, leucocytes, tracheal secretions, of installed intubated ventilator.

PaO2 / FiO2, and Photo thorax) after 72 hours
Figure 1 Suction Above Cuff Endotracheal Tube (Medical)
Data analysis SMG / EC / 2017, which stated that this

research was ethically qualified. Prior to the
Data were analyzed using IBM SPSS 21. Data
were evaluated using percentage and

frequency as well as parametric tests to
compare CPIS values after 72 hours of
mechanical ventilator installation in the
SACETT and OSS-ETT groups. The data
normality test uses Shapiro-Wilk, and
Independent t-Test is used to determine the
effect of further use of SACETT and OSS-
ETT on VAP.
Ethical consideration
This research has obtained permission from

the Health Research Commission of Health
Polytechnic of Kemenkes Semarang with
approval number: 019 / KEPK / Poltkekkes-
38
research, prospective respondents were given

informed consent which contains information
Table 1 shows that the average age of
about the purpose, benefits, and research
respondents in the SACETT group was 54.27
procedures.
years with the maximum age of 77 years and
minimum of 74 years. While the average age
of the group of OSS-ETT was 52.80 years,
with the maximum age of 74 years and
minimum of 30 years. The statistical test
RESULTS obtained p-value = 0.5819 showed the age
range data of respondents were homogeneous.
Table 1 Homogeneity test and frequency distribution of age of respondents (n=30)
*
Variable Group Mean Median SD Min Max p value
OSS-ETT 52.80 54.00 10.591 30 74
*) Mann Whitney U Test (p<0.05)
Table 2 shows that the frequency and in the SACETT group and 5 (16.7%) in the
percentage of gender of respondents consisted
of 18 (60%) of males in which 8 (26.7%) OSS-ETT group. Chi Square shows p =
males in the SACETT group and 10 (33.3%)
0.456, which indicated that gender data were
in the OSS-ETT group, while the female
homogeneous.
respondents were 12 (40%) which 7 (23.3%)
38
Table 2 Homogeneity test and frequency distribution of gender and medical diagnosis of respondents (n=30)
Group
OSS-
SACETT ETT
f % f % N %
Male 8 26.7 10 33.3 18 60.0 *
Gender 0.456
Female 7 23.3 5 16.7 12 40.0
Medical Nervous 4 13.3 4 13.3 8 26.7

diagnosis
Cardiovascular 4 13.3 8 26.7 12 40.0
**
Digestive 2 6.70 0 0.00 2 6.70 0.660
Immune 2 6.70 2 6.70 4 13.3
Urinary 3 10.0 1 3.30 4 13.3
*) Chi Square Test (p<0.05) **) Kolmogorov Smirnov (p<0.05)
Frequency distribution and percentage of in the OSS-ETT group. The lowest percentage
respondent characteristics based on medical was in digestive system as many as 2 (6.70%)
diagnoses show that 12 (40%) respondents respondents. Kolmogorov Smirnov test
with cardiovascular disease as the highest showed p-value = 0.730, which indicated that
percentage, which 4 (13.3%) respondents were the medical diagnostic data of respondents
in SACETT group and 8 (26.7%) respondents were homogeneous.
Table 3 Homogeneity test and frequency distribution of gender and medical diagnosis of confounding variables (n=30)
Group
OSS-
ETT
f % f % N %
*
0.425
Cephalosporin 5 16.7 4 13.3 9 30.0
Quinolone 2 6.7 5 16.7 7 23.3
Nitroimidazole 4 13.3 4 13.3 8 26.7
Head 30o 7 23.3 8 26.7 15 50.0 *

1.000
o
position 45 8 26.7 7 23.3 15 50.0
Diet 600 cc 4 13.3 4 13.3 8 26.7

*
800 cc 11 36.7 8 26.7 19 63.3 0.438
1000 cc 0 0.00 3 10.0 3 10.0
Circuit Disposable 8 26.7 8 26.7 16 53.3 *

1.000
38
type Reusable 7 23.3 7 23.3 14 46.7
*) Levene Test (p>0.05)
Table 3 shows that most antibiotic use is 1.000), diet (p = 0.438), circuit type (p =
cephalosporin group (30.0%), average head
position is 30-45o (50.0%), diet with the 1.000), which indicated that all confounding
variables can be controlled.
highest frequency is 800 cc (63.3%), use of
circuit type with the highest frequency is
disposable circuit (53.3%). Levene test results
Table 4 shows that there was no VAP
showed probability values for antibiotic
incidence in the SACETT group whereas in
variables (p = 0.425), head position (p =
the OSS-ETT group there were 13.3% of
respondents who experienced VAP.
Table 4 Frequency distribution and percentage of VAP incidents in patients with mechanical ventilator in the ICU (n=30)
Group
Variable Category SACETT OSS-ETT
f % f % N %
VAP No VAP 15 50.0 11 36.7 26 86.7
incident VAP 0 0.00 4 13.3 4 13.3
Total 15 50 15 50 30 100
38
Table 5 Effectiveness of the use of SACETT and OSS-ETT on VAP (n=30)
SACETT OSS-ETT
Mean + SD Mean + SD
CPIS 2.93 + 0.799 5.07 + 1.668 0.001
*) Independent t-Test (p <0.05)
The Independent t-test as shown in the table 5 (Mahmoodpoor et al., 2013). Another research
obtained p-value = 0.001, which indicated that about the age relationship of VAP patients
there was a significant difference between the with length of stay in ICU shows that the
use of SACETT and OSS-ETT on the average age of respondents installed
incidence of Ventilator Associated Pneumonia mechanical ventilator was 49 years (Dewi &
in patients with mechanical ventilator with Harahap, 2014).
reference to Clinical Pulmonary Infection
Score, which the mean of SACETT group
(2.93 SD = 0.799) was smaller than the mean Risk factors that can trigger the occurrence of
of OSS-ETT group (5.07 SD = 1.668). It can VAP include age over 60 years, disease
be concluded that CPIS value was better on severity, acute or chronic lung disease,
SACETT than SETT. excessive sedation, enteral nutrition, and
severe burns (Rab, 2010). A study states that
the age and degree of disease redness are two
DISCUSSION
Description of Respondent's Characteristics
The mean age of respondents in this study was
54.27 years in the SACETT group and 52.80

in the SETT group, which the age range of 46-
65 years was categorized as elderly (Depkes,
2009). This was consistent with the previous
study with the most respondents at the age

below 60 years (Saragih et al., 2014). Similar
with another study with the use of suction
above cuff tracheotomy in reducing the
average incidence of VAP in ICU chambers
with most respondents in the range of 43-55
years (Ledgerwood et al., 2013). The other
comparative study of polyurethane and
polyvinyl cuff on VAP showed the most
average respondents was 54 years old
38
factors which play a role in patient outcomes mechanical ventilator is a risk factor in the
in the ICU, but these relationships may be occurrence of pneumonia because the airway
affected by acute physiological disorders,
physiologic changes with age, and different
treatment in each ICU (Boumendil et al.,
2004).
The highest number of genders of respondent

was males. This was not in accordance with a
previous study that most of respondents were
females (Ledgerwood et al., 2013;
Yagmurdur, Tezcan, Karakurt, & Leblebici,
2016). However, patients critically ill in the
ICU are basically not always dominated by one
gender whether male or female. During the
study, we found more male patients treated in
the ICU with an indication of mechanical
ventilator installation. The frequency of
most respondents' medical diagnoses is a
disease of the cardiovascular system
followed by a disease of the nervous system.
A research by The Canadian Critical Care
Trials Group suggests that respondents with
the most mechanical ventilators in trauma
disease, followed by cardiovascular disease,
respiratory disease, and neurological
diseases (Group,
2006). Another study stated that most

ventilator-installed patients are in
cardiovascular system disease (Harde et al.,
2013). Another also showed that the most

respondents are with cardiovascular system
disease (Saragih et al., 2014). Conditions in
the cardiovascular system are closely related to
the respiratory system so that when there is a
disorder of the heart it will affect the
respiratory system function. When the heart is
unable to pump enough blood to maintain a
smooth circulation, the result will be a buildup
of blood and extra pressure that causes fluid to
accumulate into the lungs. When the lung has
lost its function, it requires a breathing
apparatus such as a mechanical ventilator
(Terry & Weaver, 2014). The use of
39
is intubated, so that it can be the entrance of tolerance limit of intubated mechanical

germsin the oral cavity if it is not kept clean. ventilators in enteral feeding was not greater
than 250 cc / 6 h (not more than 1000 cc / 24
h). This is because if the provision of nutrients
above the tolerable volume of the patient
increases the likelihood of vomiting and
The most antibiotic use in this study was
cephalosporin (30.0%). Cephalosporin is
antibiotic capable of passing penicillin
constraints. The drug is a semisynthetic
preparation of the Acremonium
Chepalosporium that is effective for fungus for
both positive and negative gram (Azwar &
Onk, 2004). The use of cephalosporin class
antibiotics in this study is for prophylaxis in
preventing pulmonary parenchymal infections
due to the installation of an intubated
ventilator. According to a study, 60% of
antibiotics use is cephalosporin. This is
because the majority of respondents are with
low economy i.e. patients with health
insurance. Another factor that supports the
high use of cephalosporin class antibiotics is
the very easy way of administration, once
daily in an IV or bolus (Fauziyah, Radji, &
Nurgani, 2011).
Fifty-percent of respondents have 30o and 45o

head up position. The head-up position in the
ventilator-mounted patient is essential to
prevent aspiration of the oropharyngeal tract.
A study suggests that a 15-30o back-rest
elevation is insufficient to prevent VAP, while
patients with elevated 45o semi recumbent
positions have significantly lower incidences
in VAP events (Alexiou, Ierodiakonou,
Dimopoulos, & Falagas, 2009).
Administration of enteral nutrition in this

study with the highest volume was 800 cc / 24
hours (63.3%). Patients with intubated
mechanical ventilation should be controlled in
the volumes of enteral nutrition administered
to minimize residual volume to prevent
aspiration from aerodigestive channels. This is
in accordance with a study indicated that the
39
aspiration risk in patients which also increases reduces VAP incidence and duration of
the risk of VAP (Poulard et al., 2010). mechanical ventilator use and delayed the
onset of VAP (Mao et al., 2016 ). Another
study for the incidence of VAP using
The use of disposable circuits in this study endotracheal tubes with polyurethane cuff and
(53.3%) is more than the use of reusable subglottic secretion drainage (ETT-PUC-SSD)
circuits (46.7%). During the course of the and conventional endotracheal tube by Lorente
study, patients with intubated mechanical
ventilators used more disposable circuits in
order to maintain the sterility of oxygen and
air entering the lungs during the use of
mechanical ventilators to prevent VAP.
Effectiveness Between the Use of SACETT
and OSS-ETT on VAP
VAP incidence was found in 4 (13.3%)

respondents in the OSS-ETT group and no
VAP was found in the SACETT group. In
accordance with the study by Ledgerwood et
al with the result that the incidence of VAP in
the use of suction above cuff is lower than the
use of standard tubes. This occurs because the
use of ETT model with suction port over
balloon cuff can control oral secretion in
ventilator-installed patients in order not to
enter the lungs. In contrast to the use of
standard ETT that use open suction catheters
to control secretions in the oral cavity but are
unable to reach the upper respiratory to
prevent secretion from entering the lungs so
that microbe may occur in lung tissue.
Comparative analysis is performed on the

CPIS score as a measure of incidence of VAP
with grouping of SACETT and OSS-ETT
variables in which there was significant
difference between the two groups. The results
of this study contrasted with a study by Jena et
al, in which there was no significant difference
in clinical and microbiological incidence of
VAP between the use of SACETT and
standard ETT with the conclusion that other
strategies for VAP prevention were similar
(Jena et al., 2016). Differences were suggested
by Mao et al that subglottic secretion suction
39
et al found that decreased incidence of VAP 0.2% in an effort to prevent VAP.

either early onset or late onset in treated
patients using ETT-PUC-SSD (Lorente et al.,
This study has an effect size of 1.668 with a
2007).
very strong category, meaning that this study
is able to provide better effects in preventing
VAP with the location of differences in the
Microbial agents that because pneumonia have combination of intubation using SACETT and
three forms of primary transmission, namely: oral hygiene using Chlorhexidine 0.2% twice a
(1) secretive aspiration containing pathogenic
microorganisms that have colonized the
oropharynx, (2) infectious aerosol inhalation,
and (3) hematogenous spread of the
extrapulmonary portion. The most common
way is aspiration and inhalation of infectious
agents. The colonization of microorganisms in
the oropharynx is common in 48 hours after
hospitalization, oropharyngeal secretions lead
to pathological consequences whereby normal
persons take fewer oropharyngeal secretions
during sleep and will become worse when oral
hygiene or when oral hygiene are not good.36
Suction mechanism in subglottic secretion

drainage can decrease the incidence of VAP
with continuous secret aspiration mechanisms
to prevent micro aspiration from the upper
airway into the lungs and minimize injury to
the tracheal mucosa in order to avoid
colonization of microorganisms (Lorente et al.,
2007).
VAP is closely related to the upper respiratory

hygiene level. The action in maintaining the
hygiene of the oral cavity of the patient is
installed by a mechanical ventilator intubated
by doing two important things, namely
suctioning and oral hygiene. Standard ETT
intubation with open suction is an old method
but is maintained because of the policy of most
hospitals in the area despite the risks of
contamination during suctioning. Oral hygiene
using Chlorhexidine 0.2% has been
extensively studied and has a good effect on
maintaining oral hygiene. This study combines
intubation using SACETT + Chlorhexidine
39
day. According to previous study,

Chlorhexidine 0.2% is an effective antiseptic
to decrease VAP incidence compared with
0.19% NaCl usage. Thus, it can be concluded CONCLUSION

that our study is in accordance with the results
of the previous study (Tantipong,
Morkchareonpong, Jaiyindee, & Thamlikitkul, VAP incidence based on CPIS assessment on
the fourth day was as much as 13.3% in the
2008).
use of OSS-ETT. This study showed that the
combination of intubation using SACETT and
Previously, the Closed Suction System (CSS)

method was considered capable of reducing
contamination of the upper and upper
respiratory tracts in infection prevention
efforts, but some studies did not show any
difference in the use of CSS over Open
Suction Method (OSS) methods in the
treatment of installed patients with intubated
mechanical ventilators prevention of VAP.
Based on a meta-analysis study shows that the
comparison of CSS and OSS use in VAP
prevention was not significant with CI = 1.50-
5.52, which means the use of CSS did not
provide benefit in preventing VAP compared

with OSS use (Siempos, Vardakas, & Falagas,
2008). Another also stated that there was no

difference use of CSS and OSS in the
prevention of VAP nosocomial infections in
ventilator-installed patients (Badriyah, 2016).
Meanwhile, the use of 0.2% Chlorhexidine in
OSS and CSS have the same impact in
ventilator-installed patients (Debora, Leksana,
& Sutiyono, 2012). A new method of

preventing VAP is the incorporation of a
closed suction system with ETT in a single
tool, SACETT, which minimizes the risk of
micro aspiration by suction that directly
reaches the area above the ETT cuff balloon.
The combination of SACETT and oral hygiene
intubation using Chlorhexidine 0.2% twice
daily can prevent VAP than standard ETT
intubation with an open suction system with
Chlorhexidine 0.2% twice daily as oral
hygiene.
39
oral hygiene using Chlorhexidine 0.2% twice Jurnal Ners, 297-301.

daily was more effective than standard ETT Balanchivadze, N., Dy, R., & Boyce, J. (2015). QI:
intubation with open suction system in Modified clinical pulmonary infection score as a
surrogate tool to guide antibiotic de-escalation in
preventing VAP, with p-value = 0.001. The patients with hospital-acquired, healthcare-
use of SACETT and oral hygiene using associated and ventilator-associated pneumonia in
intensive care units. Open Forum Infectious
Chlorhexidine 0.2% proved to prevent VAP in
patients <60 years old and with indications of Diseases, 2(1), 1429.
intubation in cardiovascular system disease,
Boumendil, A., Maury, E., Reinhard, I., Luquel, L.,
nervous system, immune system and urinary Offenstadt, G., & Guidet, B. (2004). Prognosis of
system and digestive system. Therefore, in the patients aged 80 years and over admitted in
medical intensive care unit. Intensive Care
prevention of VAP in critical patients, it is Medicine, 30(4), 647-654.
recommended to combine SACETT and oral
hygiene with Chlorhexidine 0.2%. Bouza, E., Brun-Buisson, C., Chastre, J., Ewig, S.,
Fagon, J.-Y., Marquette, C. H., . . . Welte, T.
(2001). Ventilator-associated pneumonia. Europian
Declaration of Conflicting Interest Respiratory Journal 17(5), 1034-1045.
None declared.
Funding
This study has been supported by Program Pascasarjana,

Magister Terapan Kesehatan, Politeknik Kesehatan
Kemenkes Semarang, Indonesia
Author Contribution
All authors contributed equally in this study.
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Cite this article as: Sukmadi, A., Pujiastuti, Rr. S. E., Santjaka, A., Supriyadi. (2018). Effectiveness of suction above
cuff endotracheal tube (SACETT) in preventing ventilator associated pneumonia in critical patients in intensive
care unit. Belitung Nursing Journal,4(4), 380-389. https://doi.org/10.33546/bnj.503
39

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TUGAS ANALISA JURNAL

PROGRAM STUDI S1 KEPERAWATAN

Judul The Comparison Of The Effect Of Effectiveness Of Suction

Peneliti Syaukia Adini, Bedjo Santoso, Arfiyan Sukmadi, Rr Sri

Tahun Publikasi 2018 2017

Tujuan Penelitian Membandingkan efektivitas madu Membandingkan kombinasi

Desain Penelitian Penelitian eksperimen semu Quasi-exsperimental dengan

Teknik Sampling Consecutive sampling Purposive sampling

Jumlah Sampling 30 pasien 30 pasien

Waktu Penelitian 24 Januari 2017 – 24 Februari 25 Juni 2017 – 5 November

Hasil Penelitian Dalam studi ini madu dan Peneitian ini

Kesimpulan Berdasarkan hasil penelitian ini Insiden VAP berdasarkan

© 2018 The Author(s)

ORIGINAL RESEARCH ISSN: 2477-4073

THE COMPARISON OF THE EFFECT OF HONEY AND

Syaukia Adini*, Bedjo Santoso, Sarkum, Sudirman

Program Pascasarjana Magister Terapan Kesehatan Keperawatan

Poltekkes Kemenkes Semarang

Keywords: 0.2% chlorhexidine; CPIS; honey; oral hygiene; VAP; ventilator

Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018

2009, in the 11 intensive care units in the

54.3 years with mortality rate of 21.7%

The VAP incidence rates in Indonesia itself

There have been several risk factors related to

Several studies have shown that antiseptics

0.12% chlorhexidine (p = 0.005). The use of

This study was a quasi-experimental study

The study was conducted from 24 January

Oral hygiene performed in both honey and

Clinical Pulmonary Infection Score (CPIS)

≥36.5 and ≤38.4; score 1 if temperature ≥38.4

≤36.0), leukocytes (per mm3) (score 0 if ≥

4,000 and ≤11,000; score 1 if <4000 and

>11,000), tracheal secretions (score 0 if no or

few secrets; score 1 if having secrets and no

>240 or ARDS; score 2 if PaO2/FiO2 ≤240

Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018

The statistical analysis was performed using

Table 1 shows that the majority of

Table 2 shows that the majority of

38.4, had secrets with no purulent, leucocytes

<4000/>11000, FiO2> 240 / ARDS, and

Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018

Age group 2.67±0.900 2.87±0.915 1.00

21-40 years 3 10 4 13.33

Table 2 Frequency distribution of respondents based on CPIS (n=30)

Honey Yes, but not purulent 11 36.67 1.27+ 0.458

Yes, purulent 4 13.33

Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018

Chlorhexidine Yes, but not purulent 9 30.00 1.27+ 0.594

Yes, purulent 5 16.67

Chlorhexidine 0.60+ 0.507

Honey 0.27+ 0.704

Honey Diffuse infiltrate 10 33.33 0.67+ 0.488

Thorax Localized infiltrate 0 0.00

photo No infiltrate 4 13.33

Chlorhexidine Diffuse infiltrate 11 36.67 0.73+ 0.421

Localized infiltrate 0 0.00

Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018

Table 3 Frequency distribution of respondents based on VAP event (n=30)

DISCUSSION <60 years or >60 years is equally at risk of

The characteristics of respondents aged

Belitung Nursing Journal, Volume 4, Issue 2, March-April 2018

ventilators have 6-12 times higher in the risk