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The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit

Department of Nursing, Barnes-Jewish Hospital, St Louis, Missouri, css1719{at}bjc.org

Jeanne E. Zack, PhD

Department of Infection Control, Barnes-Jewish Hospital, St Louis, Missouri

Marilyn E. Schallom, MSN

Department of Nursing, Barnes-Jewish Hospital, St Louis, Missouri

Maryellen McSweeney, PhD

Department of Nursing, Barnes-Jewish Hospital, St Louis, Missouri

Kathleen McMullen

Department of Nursing, Barnes-Jewish Hospital, St Louis, Missouri

James Thomas, RN, BSN

Department of Nursing, Barnes-Jewish Hospital, St Louis, Missouri

Craig M. Coopersmith, MD, FCCM

Department of Surgery, Washington University School of Medicine, St Louis, Missouri, Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri

Walter A. Boyle, MD

Department of Anesthesiology Washington University School of Medicine, St Louis, Missouri

Timothy G. Buchman, MD, PhD, FCCM

Department of Surgery, Washington University School of Medicine, St Louis, Missouri, Department of Anesthesiology Washington University School of Medicine, St Louis, Missouri

John E. Mazuski, MD, PhD

Department of Surgery, Washington University School of Medicine, St Louis, Missouri

Douglas J. E. Schuerer, MD

Department of Surgery, Washington University School of Medicine, St Louis, Missouri

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. Setting: Twenty-four bed surgical/trauma/burn intensive care units in an urban university hospital. Patients: All mechanically ventilated patients that were admitted to the intensive care unit between June 1, 2004 and May 31, 2005. 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. Measurements and main results: During the preintervention period from June 1, 2003 to May 31, 2004, 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 also monitored biweekly and averaged 81%. The total cost of the oral care protocol was US$2187.49. There were 14 fewer cases of ventilator-associated pneumonia, which led to a 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.

Key Words: pneumonia • oral care • plaque removal • chemical removal • mechanical removal

This version was published on January 1, 2009

Journal of Intensive Care Medicine, Vol. 24, No. 1, 54-62 (2009)
DOI: 10.1177/0885066608326972


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