An Evidenced Based Oral Care Protocol to Reduce Ventilator Associated Pneumonia in Critical Care

Purpose:
The purpose of the study was to examine the impact of .12% CHX rinses as one component of a comprehensive oral care protocol for all critical care patients.

Significance:
Ventilator Associcated Pneumonia is a serious, nosocomial threat to criticallly ill mechanically ventilated patients and is a major cause of morbidity, mortality and healthcare associated costs.

Strategy and Implementation:
Currently evidence based guidelines, including those available from IHI, the CDC, and American Associtation of Critical Care Nurses fail to recommend the use of CHX in critical care patients other than those under going cardiac surgery. The oral care program we were using in the past included staff cleansing and suctioning every four hours and tooth brushing evey 12 hours without CHX, except for cardiac patients. The intervention was a standardize mouth care approach for all critically ill ventilated patients: 1)use .12% CHX for all mechanically ventilated patients 2)change oral care to q6h including oral assessment, tooth brushing, application of CHX with a foam swab to teeth , oral cavity, and tongue and subglotic suctioning.

Evaluation:
Average monthly VAP rate/1000 vent days was reduced from 5.52 to 2.05. This translates to a 63% reduction in VAP rate after intervention.

Implications for Practice:
A q 6 hour oral care protocol including tooth brushing and use of .12% CHX rinse resulted in a reduction in VAP cases in the 6 month period following the intervention. For every VAP avoided, the institution will save an estimated $40-57,000.