Oral Care Protocol Combined with Ventilator Bundle Reduces VAP Rates

Monitoring for VAP after the conclusion of the three-month ventilator bundle intervention showed sustained improvement with no additional cases of VAP reported for all of 2007 (annualized VAP rate was 3.7/1,000 ventilator days). No adverse events were reported during the three-month bundle intervention period, and the CHG-containing oral kit and modified ventilator bundle were continued as standard of practice throughout 2007, ongoing in 2008. The annualized rate/1,000 ventilator days in 2006 was 14.⁸ compared to an annualized rate in 2007 of 3.⁷ (p= 0.37).

Figure 4: VAP rates 2004-2007

Discussion

Evidence-based Research on VAP Reduction/Prevention

Recent research has suggested adding comprehensive oral care to reduce the oral bacterial load also reduces rates of VAP. Oropharyngeal colonization with potentially pathogenic bacteria is pivotal in the development of VAP.¹⁶ This may be due to migration of the bacteria, aspiration, or other factors associated with bacterial spread from the oral cavity to the lungs. The use of oral antiseptics and oral care regimens has been investigated as a means of reducing the rates of VAP. Chan et al¹⁷ conducted a systematic review and meta-analysis of randomized controlled trials and concluded that oral application of antibiotics was not useful but that oral application of antiseptics did reduce rates of VAP, with a relative risk reduction of 0.39 to 0.81. Oral care programs in the ICU have led to reduced rates of VAP, with a relative risk of VAP of 0.37 in patients receiving oral care.¹⁸

Patients undergoing surgery may also benefit from oral care. VAP is the most common nosocomial infection in patients who have undergone cardiac surgery.¹⁹ Previous studies have demonstrated that oral care that includes 0.12 percent CHG oral rinse with alcohol helps reduce VAP rates in surgical patients.^7-9 In August 2006, the American Association of Critical Care Nurses released a practice alert encouraging the use of CHG oral rinse in adult cardiac surgery patients.¹⁰