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.


CONCLUSIONS
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.
Garcia
Robert
R
Brookdale University Hospital & Medical Center, USA.
Jendresky
Linda
L
Colbert
Larry
L
Bailey
Althea
A
Zaman
Mohammed
M
Majumder
Mujbur
M
D018806:APACHE; D000046:Academic Medical Centers; D000368:Aged; D003773:Dental Plaque / Q000382:microbiology; D005260:Female; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000379:methods*; D009960:Oropharynx / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D017064:Process Assessment, Health Care; D013270:Stomach / Q000382:microbiology