The Importance of Clinical Oral Care

Hospital-Acquired Pneumonia (HAP) Oral cavity plays key role in HAP development Includes ventilator- associated pneumonia (VAP) Scannapieco FA, et al., J Periodontology. 1999; 70(7); 793-802.

Hospital-Acquired Pneumonia (HAP) Defined as: Pneumonia that occurs 48 hours or more after admission, that was not incubating at the time of admission. American Thoracic Society Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005

Hospital-Acquired Pneumonia (HAP) Rate of between 5 and 10 cases per 1,000 hospital admissions Incidence of HAP increases by 6-20 fold in vented patients Accounts for up to 25% of all ICU infections Nearly 90% of ICU HAP episodes occur during mechanical ventilation Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005

Ventilator-Associated Pneumonia (VAP) Defined as: Pneumonia that arises more than 48-72 hours after endotracheal intubation. American Thoracic Society Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005

Ventilator-Associated Pneumonia (VAP) VAP has a high mortality rate and extends length of stay1 Mean hospital costs range between $40,0002 and $150,00 per episode3 Approximately half of all VAP episodes occur during the first 4 days of hospitalization1 Garcia, R., Jendresky, L., & Colbert, L. (unpublished work 2004). Reduction of microbial colonization in the oropharynx and dental plaque reduces ventilator-associated pneumonia. Kunis, K. & Puntillo, K.A. (2003). Ventilator-associated pneumonia in the ICU: its pathophysiology, risk factors, and prevention. American Journal of Nursing, 103(8), 64AA-64GG. National Nosocomial Infections surveillance (NNIS) System Report, data summary from 2004. (2004). CDC NNIS, October 2004. Richards, M.J., Edwards, J.R., Culver, D.H., & Gaynes, R.P. (1999). Nosocomial infections in medical intensive care units in the United States. Critical Care Medicine, 27(5), 887-892. Schleder, B.J. (2003). Taking charge of ventilator-associated pneumonia. Nursing Management, 34(8), 27-32. Schleder, B.J., Stott, K., & Lloyd, R.C. (2002). The Effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Journal of advocate Health Care, 4(1), 27-30. Simmons-Trau, D., Cenek, P., Counterman, J., Hockenbury, D., & Litwiller, L. (2004). Reducing VAP with 6 Sigma. Nursing Management, 35(6), 41-45. Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005 Kollef MH, et al., Chest. Dec 2005;128(6) ):3854-62

High Mortality Hospital-associated pneumonias Fatal for 20 to 33% of patients Source: Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, CDC/HICPACL 8-9.

High Mortality, Longer Stays, Increased Costs Length of Stay Mean Hospital Charges HAP 18.8% 15.2 days $65,292 VAP 29.3% 23 days $150,841 Kollef MH, et al., Chest. Dec 2005;128(6):3854-62.

VAP=Longer Stays 9.6 more days on the Vent 6.1 more days in the ICU 11.5 more days in the Hospital Rello J. et al., Chest. Dec 2002; 122(6): 2115-21

VAP=Increased Costs > $40,000 per case to treat Facility pays the bill Rello J. et al., Chest. Dec 2002; 122(6): 2115-21

$105M ORAL CARE: SUCTION and NON-SUCTION Sage Kimberly-Clark/Ballard Annual 2011 Market Kimberly-Clark/Ballard Trademark Medical Tri-State Medical Medline Others* 89.2% 6.6% 3.9% 0.3% 0.1% <0.1% each Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data * others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries,

$86.7M ORAL CARE: SUCTION Sage Kimberly-Clark/Ballard Annual 2011 Market Kimberly-Clark/Ballard Trademark Medical Medline 89.6% 6.7% 3.5% .2% Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data

$18.9M ORAL CARE: NON-SUCTION Sage Kimberly-Clark/Ballard Medline Annual 2011 Market Kimberly-Clark/Ballard Medline Others* 84.5% 5.9% 5.5% <1.1% each Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data * others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries, Tri-State, PDI

Market Review – VAP Prevention Q-Care Petite ~ 73.7 K Days 1% Q-Care Units ~ 2.1 M Days 28.5% Vent Days* (Adult and Pediatric) ~7.4 M Days Available Market: 70.5% *Source: Principal Procedure outcomes for respiratory intubation and ventilation: Healthcare Cost and Utilization Project (HCUP), 2006, http://hcupnet.ahrq.gov/; Q-Care Sales figures: Sage Sales from September 2007 – August 2008

The Effect of a Comprehensive Oral Care Protocol on Patients at Risk for Ventilator- Associated Pneumonia Implemented a comprehensive oral care program Reduced VAP by 60% Schleder B. et al., J Advocate Health Care. 2002

CDC Guidelines References Schleder’s work... “...Develop and implement a comprehensive oral-hygiene program…”. Source: Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, CDC/HICPAC:8-9.

AACN News Robert Garcia BS, MMT(ASCP),CIC Implemented a comprehensive oral care program Reduced VAP’s by 42.1% Avoided cost $722,975 Statistically Significant Vollman K, Garcia R, AACN News, August 2005, Volume 22, No. 8.

Three of the VAP Risk Factors 1) Bacterial colonization of the oropharyngeal area 2) Aspiration of subglottic secretions (routine suctioning minimizes oral secretions that can migrate to the subglottic area.) 3) Colonization of dental plaque with respiratory pathogens Schleder B. et al., J Advocate Health Care. 2002

Evidence-Based Protocol Assessment Cleaning Debriding Suctioning Moisturizing

AACN Procedure Manual for Critical Care “In addition to brushing twice daily, use oral swabs with 1.5% hydrogen peroxide solution to clean mouth every 2 to 4 hours. With each cleansing, apply a mouth moisturizer to the oral mucosa and lips to keep tissue moist” Q12 Brushing Q2-Q4 Swabbing Moisturize after each cleaning

Customize Your Protocol

Protocol Support Tool

Performance Improvement Plan

Celebrate Your Success!

Thank You For Your Time