Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

A comprehensive oral care regimen that includes the use of an oral CHG rinse clearly adds benefit to the effort to reduce VAP. In a meta-analysis looking at seven trials (including trials conducted with surgical patients) of oral care regimens that incorporated CHG, five of the seven trials reported reduced VAP rates. The authors of the meta-analysis found cardiac surgery patients benefited the most from oral care intervention.²⁰

Our intervention incorporated preprocedural and postprocedural oral care, starting with a toothbrush and oral CHG, and advancing to oral suction brushes and swabs for plaque and secretion removal and CHG and hydrogen peroxide. After adding the CHG-containing oral care kit to the protocol, our approach led to a 74 percent reduction in VAP, probably because of the combination of mechanical and chemical cleansing. In addition to the benefits of better mechanical removal of contaminated secretions via suction devices, there may be added benefit to including hydrogen peroxide in the regimen in addition to its ability as an oxidizing oral debrider. Steinberg et al.²¹ found that the use of both CHG and hydrogen peroxide for oral cleansing demonstrated a synergistic effect in reducing bacterial counts. The preoperative care and the post-extubation care are likely to have contributed to our outcomes as well as the addition of subglottic suction endotracheal tubes.

We performed a cost savings analysis by using an estimate of $40,000 excess cost per case of VAP4 (See Table 2). Cost savings in 2007 compared with 2005 were estimated to be $400,000. If CMS regulations reduce reimbursement for VAP in the future, this cost will be borne directly by the hospital.