Wednesday April 21, 2010
Oral Care Protocol for VAP (Ventilator-associated Pneumonia)

Objective: The purpose of this study was to determine the effects of a simple low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit.

Design: Preintervention and postintervention observational study in 24 beds surgical/trauma/burn intensive care units in an urban university hospital of all mechanically ventilated patients.

Interventions: An oral care protocol to assist in prevention of bacterial growth of plaque by cleaning the patients' teeth with sodium monoflurophosphate 0.7% paste and brush, rinsing with tap water, and subsequent application of a 0.12% chlorhexidine gluconate chemical solution done twice daily at 12-hour intervals.

Results:

• During the preintervention period there were 24 infections in 4606 ventilator days (rate = 5.2 infections per 1000 ventilator days). After the institution of the oral care protocol, there were 10 infections in 4158 ventilator days, resulting in a lower rate of 2.4 infections per 1000 ventilator days. This 46% reduction in ventilator-associated pneumonia was statistically significant (P = .04).
• Staff compliance with the oral care protocol during the 12-month period was averaged 81%.
• The total cost decrease in cost of US$140 000 to US$560 000 based on the estimated cost per ventilator-associated pneumonia infection of US$10 000 to US$40 000.
• There was an overall reduction in ventilator-associated pneumonia without a change to the gram-negative or gram-positive microorganism profile.

Conclusions: The implementation of a simple, low-cost oral care protocol in the surgical intensive care unit led to a significantly decreased risk of acquiring ventilator-associated pneumonia.



The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit - Journal of Intensive Care Medicine, Vol. 24, No. 1, 54-62 (2009)