Comparative study of 2 oral care protocols in intensive care units.
BACKGROUND
The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates.


METHODS
This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored.


RESULTS
A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002).


CONCLUSIONS
Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.
Hygiène Hospitalière, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Jérôme
J
Ory
Hygiène Hospitalière, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Evelyne
E
Raybaud
Réanimation Neurochirurgicale, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Russell
R
Chabanne
Réanimation Cardio Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Bernard
B
Cosserant
Réanimation Médico-Chirurgicale Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Jean Sébastien
JS
Faure
Réanimation Médico-Chirurgicale Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Renaud
R
Guérin
Réanimation Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Laure
L
Calvet
Bio-statistiques Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Bruno
B
Pereira
Santé Publique, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Charline
C
Mourgues
Réanimation Médico-Chirurgicale Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Dominique
D
Guelon
Hygiène Hospitalière, CHU Clermont-Ferrand, Clermont-Ferrand, France. Electronic address: otraore@chu-clermontferrand.fr.
Ousmane
O
Traore
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000379:methods*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D012121:Respiration, Artificial / Q000009:adverse effects*
Dental plaque; Intubated patients; Toothbrushing; Ventilator-associated pneumonia