Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

1. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia Issued April 2010

2. Expected Practice • Develop and implement a comprehensive oral hygiene program for patients at high risk for ventilator-associated pneumonia (VAP). • Brush at least twice a day • Oral chlorhexidine gluconate (0.12%) rinse twice a day for adult cardiac surgery patients • Routine use of oral chlorhexidine gluconate (0.12%) in other populations is not recommended Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

3. Scope and Impact of the Problem • Hospital-acquired infection is a significant concern. • VAP contributes to mortality. • Oral hygiene is an important intervention. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

4. Supporting Evidence • Colonization of the oropharynx contributes to VAP • Growth of pathogenic bacteria in dental plaque provides a breeding ground for microorganisms that produce VAP. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

5. Supporting Evidence • Microorganisms in the mouth translocate and colonize the lung. • Dental plaque can be removed by brushing. • The American Dental Association recommends that healthy people brush teeth twice daily to remove plaque. • Use of an oral care protocol reduces oral inflammation and improves oral health. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

6. Chlorhexidine Evidence • Oral rinse reduced respiratory infections in cardiac surgery patients • Reduced nosocomial pneumonia in patients intubated >24 hours. • In a more varied ICU population, no difference was observed in VAP, mortality, or length of stay. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

7. Chlorhexidine Evidence • A 2005 meta-analysis found no significant reduction in the incidence of hospital-acquired pneumonia or mortality rate. • The CDC guidelines recommend use only during the perioperative period for adult cardiac surgery patients; routine use is not recommended. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

8. Supporting Evidence • To date, no data from large, controlled clinical trials of oral care interventions in critical care patients other than chlorhexidine studies have been published. • Clinical reports of infection rate changes before and after implementation of oral care protocols have been noted. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

9. Actions for Nursing Practice • Ensure that your unit has written practice documents describing the oral care procedure. • Document frequency of oral care. • Include the oral care procedure as part of unit orientation. Oral Care for Patients at Risk for Ventilator-Associated Pneumonia

10. Need More Information or Help? • Practice Alerts are online at www.aacn.org. • For additional information / assistance go to the Practice Resource Network at www.aacn.org Oral Care for Patients at Risk for Ventilator-Associated Pneumonia