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

2. Oral Care for Patients at Risk for Ventilator- Associated Pneumonia 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

3. Scope and Impact of the Problem  Hospital-acquired infection is a significant concern.  VAP contributes to mortality.  Oral hygiene is an important intervention. 3 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 4

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 5

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 6

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 7

8. 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.

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 9

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 10