Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

VAP rates were calculated monthly by trained staff in the epidemiology/infection prevention and control department. The criteria for diagnosing VAP were based on the NNIS Pneumonia Flow Diagram15 (See Figure 3).

Results

Historical VAP rates

The historical monitored rates of VAP were 37.4/1,000 ventilator days in 2004 (when only the ventilator bundle was used), 39.1/1,000 days in 2005 (when the non-CHG oral care system was introduced), and 14.8/1,000 ventilator days in 2006. (See Table 1)

Table 1: Patient and VAP numbers by year

*March 2007 is the date that the protocol using the CHG-containing oral care product was initiated.

Modified ventilator bundle results

From March 2007 to May 2007, a total of 40 patients were treated with the ventilator bundle intervention and the CHG-containing oral care system. After adoption of the protocol with the CHG-containing oral care system, VAP rates decreased by 74 percent compared to 2006 (See Figure 4), and one patient developed VAP during the three-month period. After an audit, it was discovered this patient had been changed from the three-phase oral care system with CHG to non-CHG oral care during the intubation phase. The procedures were reevaluated to ensure all patients received CHG oral care during the entire perioperative period.