Development and Implementation of a Ventilator-associated Pneumonia Prevention Oral Care

Background : Ventilator-associated pneumonia (VAP) results in significant increases in both hospital stay and morbidity. A Level I Trauma Center focused attention on VAP prevention following a notable increase over a two-year period. The goal of this project was to implement a new oral care program for vented patients to decrease VAP rates. Methods : Surveillance for VAP was completed for patients at a Level 1 Trauma Center utilizing National Healthcare Safety Network pneumonia definition for critical care patients admitted from 2017 through September 2020. Infection Prevention performed a comprehensive review of ventilated patient care and VAP bundle prevention through staff interviews and shadowing of critical care nursing staff and respiratory therapists. The VAP rate was calculated by the number of VAP/ventilator days x 1000. Results : A comprehensive review of vented patients determined there was variability with oral care practices, including products, number of times oral care occurred per day and oral care documentation. The oral care bundle included (1) increase from Q6 oral care to Q4 oral care for all vented patients, (2) integration and standardization of new oral care products, (3) addition of twice daily chlorhexidine gluconate oral care for seven days post-extubation, (4) Oral Care Road Show entitled “Brush Pneumonia Away” to educate on the importance of oral care and the changes with the process and (5) ability for respiratory therapy to document on VAP bundle prevention including oral care. A 65% decrease in VAP rate occurred between 2018/2019 (9.69) and 2020 (3.31). Conclusions : Implementation of an oral care bundle in a Level I Trauma Center with a significant daily census of critically ventilated patients improved VAP rate. Oral care interventions have been recognized as an effective method in reducing the risk of VAP in critically ill patients.