Patient Safety: Reduce the Risk of Ventilator-Associated Pneumonia

ISSUE: Ventilator-associated pneumonia (VAP) is a common complication in the intensive care unit (ICU) in ventilated patients. PROJECT: To reduce the risk of healthcare-acquired, ventilator-associated pneumonia with nursing practice improvements and a comprehensive oral care program. A multidisciplinary team reviewed infection rates and current patient-care practices of ventilated patients in the ICU. Actions were taken and evaluated during a 6-month period. Intubated patients were provided oral care every 2 hours and more often as needed. Teeth were brushed every 12 hours and the mouth swabbed every 2 hours. Patients were assessed to determine the need for removal of subglottic secretions every 6- 8 hours as well as prior to repositioning the tube or deflation of the cuff. Head of bed was raised to 30 degrees at all times. A dedicated oral suction line was used. Oral-care supplies were packaged and placed in easily obtained location in patient room. The contents included one covered yankauer tip, suction handle, and y-connector; suction toothbrush with sodium bicarbonate; mouth moisturizer; and applicator swabs. The products were packaged with quantity needed for 24-hour period, with a team member reviewing products remaining in package daily and documentation of oral care. Literature review supports that frequent and aggressive oral care may reduce ventilator-associated pneumonia. RESULTS: VAP rate decreased from 6.9/1000 ventilator days to 1.9/1000. LESSONS LEARNED: Importance of involving and training staff. Best benefit was family members and an administrator noticing reduction of patient oral odor.