title: Does an oral care protocol reduce VAP in patients with a tracheostomy?
abstract: BACKGROUND
  Several studies have demonstrated that oral care with chlorhexidine gluconate (CHG) 0.12% solution reduces the incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients with endotracheal tubes in the ICU. Minimal evidence shows the effectiveness of any oral care protocols in preventing VAP in mechanically ventilated patients with tracheostomies in a step-down or progressive care unit (PCU).
  
  
  OBJECTIVE
  To determine the effectiveness of an oral care protocol in reducing the VAP rate in mechanically ventilated patients with tracheostomies in the PCU.
  
  
  METHODS
  A 12-month prospective study was conducted on 75 mechanically ventilated patients who had tracheostomies. The oral care protocol consisted of tooth brushing with toothpaste and applying CHG 0.12% solution every 12 hours. At the conclusion of the study, the VAP rate in the study population was compared with the National Health and Safety Network (NHSN) report for 2009 benchmark of 1.5 per 1,000 ventilator days.
  
  
  RESULTS
  After the oral care protocol was implemented in the PCU, the VAP rate was 1.1 per 1,000 ventilator days over 12 months, compared with the NHSN report for 2009 of 1.5 per 1,000 ventilator days.
  
  
  CONCLUSIONS
  Tooth brushing with toothpaste and applying CHG 0.12% solution may be an effective oral care protocol to reduce the VAP rate in patients in PCUs with tracheostomies who are being mechanically ventilated.
authors.affiliation: Research Medical Center, Kansas City, MO, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Conley
authors.forename: David
authors.initials: D
authors.lastname: McKinsey
authors.forename: Jason
authors.initials: J
authors.lastname: Graff
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Ramsey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000379:methods* / Q000451:nursing; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000451:nursing; D014099:Toothbrushing; D014100:Toothpastes / Q000627:therapeutic use*; D014139:Tracheostomy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D014100:Toothpastes; C010882:chlorhexidine gluconate; D002710:Chlorhexidine