Reducing ventilator associated pneumonia through advanced oral dental care: a 48 month study.
OBJECTIVE To determine the effect of implementing a comprehensive oral and dental care system and protocol on the rate of ventilator associated pneumonia. METHODS Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university affiliated medical center were studied in 2 consecutive 24 month periods. Patients in the group studied before the intervention (n 779) had no oral assessments, no suctioning of the subglottic space, no toothbrushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and toothbrushing was done twice daily. RESULTS Compliance with protocol components exceeded 80% The groups did not differ significantly in age, sex, or severity of illness. The rate of ventilator associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention (P .06) Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality. CONCLUSION Our findings suggest that use of advanced tools, a comprehensive oral care protocol, and staff compliance with the protocol can significantly reduce rates of ventilator associated pneumonia and associated costs.
American journal of critical care an official publication, American Association of Critical Care Nurses