title: Ventilator-associated pneumonia and oral care: a successful quality improvement project.
abstract: BACKGROUND
  Ventilator-associated pneumonia (VAP) is a nosocomial pneumonia that develops in patients on mechanical ventilation for >or=48 hours. VAP develops at an estimated rate of 1% to 3% per day of mechanical ventilation.
  
  
  METHODS
  Quality improvement project. Mechanically ventilated patients received the following oral care every 4 hours: the teeth were brushed with cetylpyridinium chloride (changed to 0.12% chlorhexidine gluconate in 2007) using a suction toothbrush, the oral cavity was cleansed with suction swabs treated with hydrogen peroxide, a mouth moisturizer was applied, deep oropharyngeal suctioning was performed, and suction catheters were used to control secretions. The primary efficacy variable was a diagnosis of VAP in patients mechanically ventilated for >or=48 hours.
  
  
  RESULTS
  The historical average rate of VAP in 2004 was 12.6 cases/1000 ventilator-days. After the inception of the quality improvement project, VAP rates decreased to 4.12 (VAP cases/days of ventilation x 1000) for May to December 2005, to 3.57 for 2006, and to 1.3 for 2007.
  
  
  CONCLUSIONS
  The use of an oral care protocol intervention and ventilator bundle led to an 89.7% reduction in the VAP rate in mechanically ventilated patients from 2004 to 2007.
authors.affiliation: Critical Care Unit, Mercy Medical Center, Springfield, MA 01102-9012, USA. kathleen.hutchins@sphs.com
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hutchins
authors.forename: George
authors.initials: G
authors.lastname: Karras
authors.forename: Joan
authors.initials: J
authors.lastname: Erwin
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Sullivan
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D009067:Mouthwashes; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011787:Quality of Health Care; D012121:Respiration, Artificial / Q000009:adverse effects; D014099:Toothbrushing
chemical_list: D009067:Mouthwashes