Best practice: Reduce VAP rates with a toothbrush

HCPro's Weekly Update on the ANCC Magnet Recognition Program®*, May 26, 2009

When the surgical intensive care unit (SICU) at Barnes-Jewish Hospital (BJH) in St. Louis, MO, wasn’t seeing a decline in its ventilator-associated pneumonia (VAP) rate, leadership questioned what else it could do. “We were following the Centers for Disease Control and Prevention guidelines, and pretty much doing all of the high-grade interventions,” says Lynn Schallom, RN, MSN, CCNS, a surgical critical care clinical nurse specialist. “But there were other lower level recommendations that we weren’t doing and one of those was oral care.”

The 24-bed SICU had 5.2 cases of VAP per 1,000 ventilator days in 2006. So Carrie Sona, RN, MSN, CCNS, a surgical critical care clinical nurse specialist at BJH—an ANCC Magnet Recognition Program® redesignation recipient in 2008—and Schallom conducted a year-long research study that showed regular oral care for patients on ventilators can help reduce incidents of VAP by at least 50%.

The nurses were educated on this new protocol with detailed pictorials and inservices that showed nurses the benefits of oral care. Nurses now brush patients’ teeth for one minute and provide 15ml of .12% chlorhexidine gluconate solution every 12 hours until the patient is liberated from mechanical ventilation. The brushing and mouthwash prevents bacteria in the mouth from being aspirated and ending up in the lungs.

With the help of oral care, VAP in the SICU is currently down to 1.5 cases per 1,000 ventilator days.

Source: HCPro’s Advisor to the ANCC Magnet Recognition Program®, May issue. Don't have a subscription? Take a look at the benefits of becoming a member of HCPro’s Resource Center for the ANCC Magnet Recognition Program®.

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