Reducing Ventilator-Associated Pneumonia Through Advanced Oral-Dental Care: A 48-Month Study
- Robert Garcia, BS, MMT (ASCP), CIC,
- Linda Jendresky, MPH, CIC, CPHQ,
- Larry Colbert, MS, CIC,
- Althea Bailey, RN, MS,
- Mohammed Zaman, MD and
- Mujbur Majumder, MD
- Robert Garcia is the former Assistant Director of Infection Control at Brookdale University Hospital & Medical Center (BUMC) and is currently a Senior Instructional Support Specialist, Healthcare Epidemiology, at the State University of New York, Stony Brook. Linda Jendresky is the former Director of Infection Control at BUMC and is currently Associate Executive Director of Quality and Patient Safety at Schneiders Childrens Hospital, New York. Larry Colbert is an infection control coordinator, Althea Bailey is a nurse manager in the medical intensive care unit, Mohammed Zaman is chief of the medical intensive care unit and a professor in the Department of Pulmonary Medicine, and Mujbur Majumder is an attending physician in the medical intensive care unit and a professor in the Department of Pulmonary Medicine, all at BUMC in Brooklyn, New York.
- Corresponding author:
Robert Garcia, bs, mmt (ascp), cic, Stony Brook University Hospital & Medical Center, Nicolls Road and Health Sciences Drive, Stony Brook, NY, 11794 (e-mail: rgarciaicp{at}aol.com).
Abstract
Objective To determine the effect of implementing a comprehensive oral and dental care system and protocol on the rate of ventilator-associated pneumonia.
Methods Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university-affiliated medical center were studied in 2 consecutive 24-month periods. Patients in the group studied before the intervention (n = 779) had no oral assessments, no suctioning of the subglottic space, no toothbrushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n = 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and toothbrushing was done twice daily.
Results Compliance with protocol components exceeded 80%. The groups did not differ significantly in age, sex, or severity of illness. The rate of ventilator-associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention (P = .06). Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality.
Conclusion Our findings suggest that use of advanced tools, a comprehensive oral care protocol, and staff compliance with the protocol can significantly reduce rates of ventilator-associated pneumonia and associated costs.
- ©2009 American Association of Critical-Care Nurses
