title: The impact of a simple, low-cost oral care protocol on ventilator-associated pneumonia rates in a surgical intensive care unit.
abstract: 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.
  
  
  METHODS
  Preintervention and postintervention observational study.
  
  
  METHODS
  Twenty-four bed surgical/trauma/burn intensive care units in an urban university hospital.
  
  
  METHODS
  All mechanically ventilated patients that were admitted to the intensive care unit between June 1, 2004 and May 31, 2005.
  
  
  METHODS
  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 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.
authors.affiliation: Departments of Nursing, Barnes-Jewish Hospital, St Louis, Missouri, USA. css1719@bjc.org
authors.forename: Carrie S
authors.initials: CS
authors.lastname: Sona
authors.forename: Jeanne E
authors.initials: JE
authors.lastname: Zack
authors.forename: Marilyn E
authors.initials: ME
authors.lastname: Schallom
authors.forename: Maryellen
authors.initials: M
authors.lastname: McSweeney
authors.forename: Kathleen
authors.initials: K
authors.lastname: McMullen
authors.forename: James
authors.initials: J
authors.lastname: Thomas
authors.forename: Craig M
authors.initials: CM
authors.lastname: Coopersmith
authors.forename: Walter A
authors.initials: WA
authors.lastname: Boyle
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Buchman
authors.forename: John E
authors.initials: JE
authors.lastname: Mazuski
authors.forename: Douglas J E
authors.initials: DJ
authors.lastname: Schuerer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002327:Cariostatic Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D003422:Critical Care; D005260:Female; D005459:Fluorides / Q000627:therapeutic use; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000191:economics* / Q000379:methods* / Q000451:nursing; D010710:Phosphates / Q000627:therapeutic use; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control*; D015397:Program Evaluation; D055815:Young Adult
chemical_list: D002327:Cariostatic Agents; D010710:Phosphates; C012980:fluorophosphate; D005459:Fluorides