My Patients Have THAT in Their Mouths? Identifying Patients at Risk for Pneumonia

BACKGROUND: Processes that identify and reduce patient risk for nosocomial infections will be essential for compliance with the Joint Commission on Accreditation of Healthcare Organizationʹs National Patient Safety Goal #7 and Standards. The prevention of pneumonia through oral care interventions is being explored to reduce oropharyngeal and dental plaque colonization as a risk factor, especially in the intubated, mechanically ventilated (MV) patient. The objective of this study was to describe colonization rates in the first 24 hours of patients placed on MV. METHODS: Patients were randomly selected for dental plaque and/or pharyngeal cultures in eight ICUs across five hospitals from December 2002 through August 2003. Specimens were serially diluted to obtain quantitative colony counts. Potential respiratory pathogens (PRP) were identified through standard microbiological identification methods. RESULTS: Fifty patients were cultured from 2621 patients placed on MV. Sixty-six percent of the patients were colonized with PRP. The most frequently isolated pathogen was Staphylococcus aureus (66%), with 64% of those isolates being methicillin-resistant. The other potentially antibiotic-resistant organisms were Enterobacter 24%, Pseudomonas (9%), and Acinetobacter (3%). CONCLUSIONS: The high rate of colonization of intubated MV patients at less than 24 hours indicates that this population is already colonized prior to intubation and at increased risk for tracheal colonization or aspiration of potential respiratory pathogens during the intubation procedure. Efforts targeting preventive oral interventions like mechanical cleansing, the removal of dental plaque by toothbrushing, and/or the use of an antimicrobial oral rinse reducing bacterial load may prevent or reverse colonization.