Ventilator-associated pneumonia (VAP) is the second-most common healthcare infection. As defined by the Institute for Healthcare Improvement (IHI), VAP is an airway infection that must develop more than 48 hours after the patient was intubated. The definition of VAP is simple, but the consequences are not. The financial strife VAP causes to medical systems is huge, and the cost to family’s who lose loved ones is enormous and cannot be measured.
According to Suzanne Pear, RN, PhD, CIC, associate director for infection prevention practices at Kimberly-Clark Health Care:
– 1 out of 4 ICU infections is VAP
– 90 percent of the pneumonias in intensive care units (ICUs) are VAP
– VAP affects 9 percent to 27 percent of ventilated patients
– VAP increases need for ventilator support and ICU stay by four to six days
– VAP costs $20,000 to $40,000 per episode
Proper oral hygiene is very important in the prevention of VAP. Pear discussed this matter with Infection Control Today and offered applicable strategies for healthcare teams.
ICT: What are the most commonly ignored steps in the VAP-prevention oral care process?
Pear: There are a number of components of oral care that may not be provided with the frequency and thoroughness that they should. Comprehensive oral hygiene begins with an admission assessment of the patient’s mouth, and self-care deficits as a baseline to gage the extent of needed interventions, and from which to measure progress.1
If oral health issues are not a routine part of the admission process, it is doubtful that it would consistently be part of the patient care plan. I wonder how many healthcare facilities incorporate oral health assessments upon admission and regularly thereafter as part of basic nursing care for all patients.
One other thing that I am particularly concerned about is the routine use of antiseptic rinses — such as chlorhexidine gluconate (CHG) 0.12 percent — possibly taking the place of, instead of as an adjunct to, mechanical biofilm debridement and cleaning of teeth, tongue, and oral mucus membranes, using a soft toothbrush, and frequent oral moisture replacement.2,3 A couple of meta-analyses have concluded that while CHG rinse does reduce VAP incidence, it does not shorten patient ventilator duration, or decrease mortality.4,5 If used, CHG should be part of a more comprehensive oral care bundle, not be its sole component, as CHG has not been found to be effective on gram negative bacteria,6 a major cause of late-onset VAP.7
