Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

Modified ventilation bundle intervention

The initial oral care protocol did not contain CHG rinse and was used only during intubation. The initial protocols were continued and updated during the ventilation bundle intervention period from March 2007 through May 2007, but during this time period, the oral care products were changed to a kit containing a 0.12 percent CHG/11.6 percent alcohol rinse manufactured by Sage Products Inc.

The modified intervention bundle was implemented from March 2007 through May 2007 in the cardiovascular intensive care unit at Ball Memorial Hospital in the open-heart surgery patient population. All patients undergoing cardiac surgery were treated with the ventilator bundle. Based on discussions with the IRB officer, it was determined the project did not require IRB review on the basis of government regulation 45 CFR 46 102 (d)14. Historical VAP rates were collected from 2004 through end-2006 for comparative purposes. It was determined that if VAP rates were improved and nursing satisfaction was high over the three months of modified ventilator bundle implementation, the bundle would be adopted as standard of practice.

A prepackaged oral care system provided supplies for oral care to be administered in three phases during the three-month period using the updated protocol and modified intervention bundle. The CHG protocol was added to the standing open-heart order set to ensure delivery of the new oral care protocol. Pharmacy services added the CHG oral care system to the electronic medication administration record for documentation as a reminder of each dose that was due. Every two-hour oral care was documented in the electronic medical record by nurses. An audit form was completed daily on each intubated patient and faxed to epidemiology (See Figure 2). The primary outcome measure was the incidence of VAP.