809

Abstract

Introduction: The purpose of the project was to improve compliance with oral care and to determine if the use of chlorhexidine gluconate (CHG) with tooth brushing would have an effect on the incidence of ventilator associated pneumonia (VAP) in patients requiring mechanical ventilation. VAP is a largely preventable complication of mechanical ventilation. The mortality rate ranges from 20-41% depending on organism, microbial therapy and underlying diseases. VAP increases length of stay 4-14 days and increases ventilator days by 4 which leads to increased costs of care averaging $26,000 per case. Methods: Based on review of the literature, we determined that we could improve patient outcomes by instituting CHG oral care. The use of CHG tooth brushing twice daily in patients requiring mechanical ventilation was initiated in February 2010. An inter-professional team adopted the strategy and a team of ICU nurse champions developed a protocol and a plan for instituting oral care with CHG. This plan included education for staff, patients and family members. Rounds were conducted to assess whether kits had been used appropriately, a standard time was set for placing the 24 hour oral care kit on a holder in a visible place in the patient's room. Compliance for oral care was monitored before and after the intervention. Results: VAP rates were measured from 2009 prior to the study period and for six months after the CHG oral care protocol was implemented. VAP rates were reduced from 2.8/1000 to 1.86/1000 ventilator days as of 2012. Compliance with oral care improved from 85% to 95-98% after a visual cue was recommended in the elctronic medical record. Conclusions: The use of CHG oral care has contributed to reductions in VAP. Implications for the initiative is that further study is needed to determine if the difference in the VAP rates continue to improve and to determine sustainability. A recommendation to have an electronic visual cue improved compliance with documenting oral care. The present recommendation is to continue using oral care with tooth brushing twice daily with CHG.