The Use of Oral Care Kits as a Strategy To Reduce Ventilator Associated Pneumonia Rates in a Surgical Intensive Care Unit

ISSUE: Despite educational efforts and enforcement of CDC guidelines for the prevention of hospital acquired ventilator associated pneumonia, including attention to oral care, infection rates remained elevated above the established acceptable threshold. A multidisciplinary team, including physicians, nurses and respiratory therapists examined the practices of the unit. An analysis of risk factors that contributed to the elevated rates concluded that nursing and respiratory therapy staff had difficulty providing meticulous attention to oral care due to inconvenience of oral care supplies and difficulty remembering to perform oral care at the recommended time intervals of every four hours. PROJECT: A study utilitzing prepackaged oral care kits in the SICU as a measure to increase compliance with oral care protocol as a strategy to reduce VAP was designed and initiated. No other practice was changed. Education and orientation on the use of the prepackaged oral care kit was provided to all nursing and respiratory therapy staff prior to starting the project. In November 2004, oral care kits were placed at patient bedsides in the SICU. The kits were packaged in bundles which contained all cleansing and suctioning tools necessary for complete oral care for a twenty-four hour period. The bundles were divided into sections which were detached every four hours, used, and discarded. Compliance with use of the kits was monitored and documented by unit personnel. Infection Control personnel also monitored and encouraged compliance during frequent rounds. Purchasing records were tracked by the Infection Control Department. RESULTS: A comparison of rates was made over a sixteen month period, including eight months prior to and after introduction of the oral care kits. A sixty-nine percent reduction of nosocomial VAP rates was demonstrated after introduction of the kits, from 13.2 per 1000 ventilator days to 5.0 infections per 1000 ventilator days.Use of the kits rsulted in $265,155.00 in cost avoidance (cost to treat VAP minus the cost of the kits). LESSONS LEARNED: Improving compliance with CDC and institutional guidelines regarding care of the ventilated patient through education and provision of convenient, innovative tools, with emphasis on aseptic technique resulted in a significant decrease in nosocomial ventilator associated pneumonia and a significant financial savings.