Removal of oral secretion prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study.
OBJECTIVE
The purpose of this study was to explore the effect of oral secretion on aspiration and reducing ventilator-associated pneumonia.


BACKGROUND
Ventilator-associated pneumonia is a serious hospital-acquired infection with reported incidence rate of 12.2% and mortality rate of 29.3%. Oral secretion is purported as a media which brings the oropharyngeal pathogens down to the respiratory track.


METHODS
Two-group comparison study design was adopted. Subjects were recruited from an adult general intensive care unit of a medical centre in Taipei city. Patients in the study group received suction of oral secretion before each positional care, in contrast with patients in the control group who received routine care.


RESULTS
Ventilator-associated pneumonia was found in 24 of 159 (15.1%) patients in the control group and in five of 102 (4.9%) patients in the study group with a reduction of risk ratio of 0.32 (95% CI 0.11-0.92). Eight of the 24 ventilator-associated pneumonia patients died in the control group; however, none of those ventilator-associated pneumonia patients died in the study group. The increased chance of survival was 1.50 (95% CI 1.13-1.99). The length of stay in ICU and duration of mechanical ventilation were reduced in the study group. In consideration of cost, the cost of tubes used to remove oral secretion is much less than the one used to do continuous subglottal suction.


CONCLUSIONS
Removal of oral secretion is effective in reducing the incidence of ventilator-associated pneumonia with minimum cost intervention.


CONCLUSIONS
This study provides evidence that removal of oral secretion prior to position change is cost effective to reduce the incidence of ventilator-associated pneumonia. As such intervention is an easy task, routine removal of oral secretion is recommended as the standard of daily nursing care of patients on ventilator.
Chao
Yann-Fen C
YF
College of Nursing, Taipei Medical University, Taipei, Taiwan. yfchao@tmu.edu.tw
Chen
Yin-Yin
YY
Wang
Kai-Wei Katherine
KW
Lee
Ru-Pin
RP
Tsai
Hweifar
H
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009093:Mucus; D018410:Pneumonia, Bacterial / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*; D040242:Risk Reduction Behavior; D013396:Suction; D013624:Taiwan / Q000453:epidemiology