Effectiveness of an Oral Care Protocol for Preventing Ventilator-Associated Pneumonia

Abstract

This study attempted to establish an oral care protocol (OCP) with 1% chlorhexidine gluconate for mechanical-ventilated critically ill patients, and to test its effectiveness in improving oral hygiene, reducing colonization of the oral cavity, and ventilator-associated pneumonia. Method: Using a double-blind, randomized, experimental study design; 202 critically ill mechanical-ventilated patients from the intensive care unit of a medical center were enrolled in this study. One hundred and forty one patients met the retention criteria and remained in the study. The control group (n=74) received routine oral care, while the experimental group (n=67) received OCP care daily. The research tools included dental plaque assessment, indicators of ventilator-associated pneumonia and microbiological analysis of oral and tracheal secretions. Basic information was collected from both groups within 24 hours after intubation, and then on days 6 and 14 following the oral care interventions. Results: The experimental group receiving OCP had better oral hygiene (p=＜.001) and less colonization of oral and tracheal secretion (p=＜.001). Meanwhile, the control group had higher rates of VAP infection (odds ratio: 5.01, 95% C.I.=1.43-19.65), significantly longer period of ventilator dependence (16.56 days vs. 11.16 days, p=.01) and length of stay in ICU than the experimental group (18.02 days vs. 13.07 days, p=.02). However, there was no significant difference between two groups in extubation rates. Conclusions: This study designed a standardized OCP for critically ill patients that has proved its effectiveness in improving oral hygiene and reducing VAP rate.