Oral Care, Ventilator-Associated Pneumonia, and Counting Cultures

2009 ◽  
Vol 18 (6) ◽  
pp. 507-509
Author(s):  
Christelle Lizy ◽  
Nele Brusselaers ◽  
Sonia Labeau ◽  
Dominique Vandijck ◽  
David De Wandel ◽  
...  
Keyword(s):  
Oral Care ◽  
Ventilator Associated Pneumonia

Nurses’ Implementation of Guidelines for Ventilator-Associated Pneumonia From the Centers for Disease Control and Prevention

2007 ◽  
Vol 16 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Carolyn L. Cason ◽  
Tracy Tyner ◽  
Sue Saunders ◽  
Lisa Broome
Keyword(s):  
Intensive Care ◽  
Disease Control ◽  
Intensive Care Units ◽  
Oral Care ◽  
The United States ◽  
Hand Washing ◽  
Ventilator Associated Pneumonia ◽  
Care Protocol ◽  
Control And Prevention ◽  
Centers For Disease Control

• Background Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. • Objective To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. • Methods Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. • Results Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. • Conclusions The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

scholarly journals Oral Care Effect on Intubated Patient with 0.2 per cent Chlorhexidine Gluconate and Tooth Brushing in Intensive Care Unit

2017 ◽  
Vol 8 (1-2) ◽  
pp. 26-33
Author(s):  
Mohammad Khan ◽  
Zeehaida Mohamed ◽  
Saedah Ali ◽  
Norkhafizah Saddki ◽  
Sam’an Malik Masudi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Oral Care ◽  
Chlorhexidine Gluconate ◽  
Tooth Brushing ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Statistical Software ◽  
Patient Screening ◽  
Experimental Group

Aims and Objectives: Ventilator-associated pneumonia is associated with increased morbidity and mortality. The aim of this pilot study was to determine the effectiveness of oral care with both tooth brushing and 0.2 per cent chlor-hexidine gluconate compared to 0.2 per cent chlorhexidine gluconate alone for the intubated patient in an intensive care unit (ICU). Materials and Methods: Patient screening was done over a period of two months. After taking informed consent, those ICU patients were divided into two groups. Only nine subjects were enrolled. During the study, the experimental group (N = 4) got oral care that consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate thrice a day. The control group got oral care with 0.2 per cent chlorhexidine gluconate alone thrice a day. The data were analysed by IBM statistical software SPPS, version 24. Results: Preliminary results suggest that the risk of ventilator-associated pneumonia in intubated patients can be reduced by maintaining thrice-daily oral care involving both tooth brushing and 0.2 per cent chlorhexidine gluconate. Conclusion: Thrice-daily oral care consisted of both tooth brushing and 0.2 per cent chlorhexidine gluconate might be a promise as a ventilator-associated pneumonia-reduction strategy in ICU. Furthermore, more studies are required for its application widely.

Oropharyngeal Decontamination with Antiseptics to Prevent Ventilator-Associated Pneumonia: Rethinking the Benefits of Chlorhexidine

2017 ◽  
Vol 38 (03) ◽  
pp. 381-390 ◽  
Author(s):  
Michael Klompas
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Meta Analysis ◽  
Unit Length ◽  
Oral Care ◽  
Care Practice ◽  
Equal Weight ◽  
Ventilator Associated Pneumonia ◽  
Meta Analyses ◽  
Double Blinded

AbstractDaily oral care with chlorhexidine for mechanically ventilated patients is ubiquitous in contemporary intensive care practice. The practice is predicated upon meta-analyses suggesting that adding chlorhexidine to daily oral care regimens can reduce ventilator-associated pneumonia (VAP) rates by up to 40%. Close analysis, however, raises three concerns: (1) the meta-analyses are dominated by studies in cardiac surgery patients in whom average duration of mechanical ventilation is < 1 day and thus their risk of VAP is very different from other populations, (2) diagnosing VAP is subjective and nonspecific yet the meta-analyses gave equal weight to blinded and nonblinded studies, potentially biasing them in favor of chlorhexidine, and (3) there is circularity between diagnostic criteria for VAP and chlorhexidine; as an antiseptic, chlorhexidine may decrease the frequency of positive respiratory cultures but fewer cultures does not necessarily mean fewer pneumonias. It is therefore important to look at other outcomes for corollary evidence on whether or not oral chlorhexidine benefits patients. An updated meta-analysis restricted to double-blinded studies in noncardiac surgery patients showed no impact on VAP rates, duration of mechanical ventilation, or intensive care unit length of stay. Instead, there was a possible signal that oral chlorhexidine may increase mortality rates. Observational data have raised similar concerns. This article will review the theoretical basis for adding chlorhexidine to oral care regimens, delineate potential biases in randomized controlled trials comparing oral care regimens with and without chlorhexidine, explore the unexpected mortality signal associated with oral chlorhexidine, and provide practical recommendations.

Using Evidence-Based Practice to Prevent Ventilator-Associated Pneumonia

2012 ◽  
Vol 32 (4) ◽  
pp. 41-51 ◽  
Author(s):  
Mary Beth Sedwick ◽  
Mary Lance-Smith ◽  
Sara J. Reeder ◽  
Jessica Nardi
Keyword(s):  
Interdisciplinary Collaboration ◽  
Compliance Rate ◽  
Oral Care ◽  
Feedback System ◽  
Ventilator Associated Pneumonia ◽  
Strict Adherence ◽  
Ulcer Disease ◽  
Vein Thrombosis ◽  
Care Protocol ◽  
Healthcare Improvement

BackgroundStrategies are needed to help prevent ventilator-associated pneumonia.ObjectiveTo develop a ventilator bundle and care practices for nurses in critical care units to reduce the rate of ventilator-associated pneumonia.MethodThe ventilator bundle developed by the Institute for Healthcare Improvement was expanded to include protocols for mouth care and hand washing, head-of-bed alarms, subglottic suctioning, and use of an electronic compliance feedback tool. Compliance audits were used to provide immediate electronic feedback.ResultsAdherence to practices included in the bundle increased. Compliance rates were greater than 98% for prophylaxis for peptic ulcer disease and deep-vein thrombosis, interruption of sedation, and elevation of the head of the bed. The compliance rate for the oral care protocol increased from 76% to 96.8%. Readiness for extubation reached at least 92.4%. Rates of ventilator-associated pneumonia decreased from 9.47 to 1.9 cases per 1000 ventilator days. The decrease in rates produced an estimated savings of approximately $1.5 million.ConclusionStrict adherence to bundled practices for preventing ventilator-associated pneumonia, enhanced accountability for initiating protocols, use of a feedback system, and interdisciplinary collaboration improved patients’ outcomes and produced marked savings in costs.

The impact of oral care on oral health status and prevention of ventilator-associated pneumonia in critically ill patients

2017 ◽  
Vol 30 (2) ◽  
pp. 69-73 ◽  
Author(s):  
Abdullah Haghighi ◽  
Vida Shafipour ◽  
Masoumeh Bagheri-Nesami ◽  
Afshin Gholipour Baradari ◽  
Jamshid Yazdani Charati
Keyword(s):  
Health Status ◽  
Oral Health ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Oral Care ◽  
Oral Health Status ◽  
Ventilator Associated Pneumonia ◽  
The Impact

The Impact of a Simple, Low-cost Oral Care Protocol on Ventilator-associated Pneumonia Rates in a Surgical Intensive Care Unit

2008 ◽  
Vol 24 (1) ◽  
pp. 54-62 ◽  
Author(s):  
Carrie S. Sona ◽  
Jeanne E. Zack ◽  
Marilyn E. Schallom ◽  
Maryellen McSweeney ◽  
Kathleen McMullen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Low Cost ◽  
Oral Care ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Surgical Intensive Care ◽  
Care Protocol ◽  
The Impact

scholarly journals Does Oral Chlorhexidine Mouth Care Prior to Intubation Impact Ventilator-Associated Pneumonia? A Systematic Review

2021 ◽  
Author(s):  
Hannah Rothhaar
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Selection Process ◽  
Proper Time ◽  
Oral Care ◽  
Ventilator Associated Pneumonia ◽  
Inclusion Criteria ◽  
Mouth Care ◽  
Application Procedure ◽  
Meta Analyses

Background: Chlorhexidine gluconate (CHG) is a broad-spectrum antiseptic agent that has become widely used for mouth care in intubated patients. Many studies have found it to be effective in the prevention of ventilator-associated pneumonia (VAP) when used after intubation; however, there is very limited research exploring the proper time to initiate CHG. Purpose: The purpose of this systematic review was to determine if the use of oral care with CHG prior to intubation impacts the incidence of VAP. Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to guide the selection process of articles and the Critical Appraisal Skills Programme (CASP) was used to critically appraise the randomized control trials (RCTs) selected for this systematic review. Four randomized RCTs met inclusion criteria. Results: Three of the four RCTs which met inclusion criteria, Houston et al. (2002), DeRiso et al. (1996), and Lin et al. (2015), showed an improvement in VAP rates with the use of preintubation CHG in cardiac surgery patients. Only one RCT, the Munro et al. (2015) study, showed no benefit; this was the only study that included non-cardiac surgery patients. Conclusion: Based on the results of this systematic review, it can only be recommended that cardiac surgery patients receive CHG prior to or after intubation; however, more research needs to be done to determine the most effective dosing, frequency, and CHG application procedure. In addition, further study exploring the safety of administering CHG prior to intubation in noncardiac surgery patients is needed.

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