Effect of an oral care protocol in preventing ventilator-associated pneumonia in ICU patients

Introduction

Ventilator-associated pneumonia (VAP) remains a major complication for patients incubated with ventilators. Most cases are attributed to increased bacteria flora in the oropharyngeal secretion and aspiration of those organisms. Evidence exists suggesting that oral care could reduce bacterial flora, prevent aspiration, and subsequently decrease the incidence of VAP for patients with ventilators. This study aims to evaluate the effectiveness of a standardized oral care protocol in improving oral hygiene and reducing the incidence of VAP in a sample of surgical patients in the ICU (SICU).

Methods

Patients newly admitted to the SICU who were under ventilator support for 48–72 hours and without pneumonia present were enrolled during March–November 2007 from a tertiary medical center in Taiwan. Subjects were randomized into the experimental or control groups and both received a 7-day oral care protocol. For the experimental group (EG), a standardized 20-minute oral care protocol was performed using an electronic toothbrush to clean and moisturize oral cavity twice daily. For the control group (CG), a mimic 20-minute protocol involving moisturizing and attention control was performed for the same intervals. The incidence of VAP defined by the Clinical Pulmonary Infection Score and the oral hygiene measured by the Oral Assessment Guide (OAG) and plaque index were compared between the two groups. Variables were compared by the analysis of Fisher exact test, chi-square test, and Mann–Whitney U test. P < 0.05 was considered significant.

Results

Forty-four patients were studied with a mean age of 60.6 ± 16.1 years, 63.6% being males. The results showed that the cumulative incidence of VAP was significantly lower in the EG, with 22.7% occurrence in the EG and 77.8% in the CG on day 9 (P < 0.05). In terms of oral hygiene, subjects in the EG performed significantly better on both OAG scores and plaque index. Specifically, the OAG decreased from 16.3 ± 1.9 to 14.9 ± 2.6 in the EG and remained high from 16.5 ± 1.6 to 16.6 ± 2.1 in the CG (P < 0.05). The plaque index was decreased from 0.76 ± 0.14 to 0.49 ± 0.18 in the EG and remained high from 0.74 ± 0.13 to 0.75 ± 0.21 in the CG (P < 0.05).

Conclusion

The findings support the effectiveness of an oral care protocol in preventing VAP and improving oral hygiene for patients admitted to the SICU with ventilator support.