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Oral Care &

Ventilator Associated
Pneumonia
Eric Johnson

PICO Question
Patients

who are intubated and on a mechanical


ventilator, how effective is oral care in reducing
ventilator-associated pneumonia compared to no
oral care?

Searching for Research

Search Words/Phrases

Oral Care
Pneumonia
Ventilator
VAP bundle
Ventilator Associated Pneumonia
Sage Oral Care
ICU Oral Care

Search Engine
Google

Search Results

Sage Oral Care Webpage


American Journal of Critical Care
American Association of Critical-Care
Nurses
Journal of Advocate Healthcare

Research Articles
Oral

Care Intervention to Reduce Incidence of VentilatorAssociated Pneumonia in the Neurologic Intensive Care unit

Fields, L. B. (2008). Oral care intervention to reduce incidence of ventilator-associated pneumonia in the
intensive care unit. The Journal of Neuroscience Nursing. Retrieved from

neurologic

http://www.medscape.com/viewarticle/582571

Reducing Ventilator-Associated Pneumonia Through Advanced OralDental Care: A 48-Month Study


Garcia, R., Jendresky, L., Colbert, L., Bailey, A., Zaman, M., & Majumder, M. (2009). Reducing ventilator-

pneumonia through advanced oral-dental care: a 48- month study. American Journal of
doi:10.4037/ajcc2009311

Critical Care.

associated

Rationale for Articles

Data proving oral care reduces ventilator-associated


pneumonia

Protocol for appropriate and effective oral care

Articles discuss increased risk of ventilator-associated


pneumonia with improper/no oral care

Reliable and credible sources

Research Article 1

Study

(Medscape Neurologic ICU)

Analytical

Design

Hierarchy of Evidence Level II


Randomized Controlled Trial

Method

Quantitative
Randomized patients
Two different oral care schedules/methods

Findings/Results

Reduced rate in Ventilator-Assisted Pneumonia after 6 months for group randomly


selected for oral care tooth brushing schedule. VAP dropped to 0% per 1,000
ventilator days, and was sustained at 0% for 6 months. New oral schedule was
implemented for all patients after 6 months and study was ended.

Ethical Consideration for Study


Article 1

(Medscape Neurologic ICU)

Hospital Protocol Ventilator-Associated Bundle Still


Implemented

Elevating head of bed to 30 degrees


Hand washing and gloving
Increase mobility
Daily sedation interruption (sedation vacation)
Use of H2 blockers to prevent ulcers
Measures taken to prevent deep vein thrombosis

Study was approved after an expedited review determining no thereat to


patient care

Oral care was still performed on all patients (difference in brushing


schedules)

Article 1 Breakdown
(Medscape Neurologic ICU)

Strengths

Randomized
Showed very fast results
Shows link between oral care and ventilator-assisted pneumonia
Conducted from evidence based practice

Quality

Compliance of staff
Randomized
Data collection

Credibility

Peer reviewed
Statistical information from hospital

Article Contributes to, and further proves evidence based practice that is
currently being implemented in the ICU.

Oral care from study is increased from teeth being brushed every 12 hours, or
as needed, to every 8 hours.

Research Article 2

(American Journal of Critical Care - 48 month study)

Study

Analytical

Design

Hierarchy of Evidence Level III


Quasi-Experimental: Nonequivalent Control Group Design

Method

Quantitative

48 month trial

Control group first 24 month period


Study/Intervention group second 24 month period

Findings/Results

Reduced rate in Ventilator-Associated Pneumonia between control group and


intervention group. Reduced rates from 12 cases per 1000 ventilator days to 8 cases
per 1000 ventilator days.

Ethical Consideration For Study


Article 2

(American Journal of Critical Care - 48 month study)

Ventilator-Associated Bundle Still Implemented (90%


compliance)

Changing ventilator circuit every 7 days


Replacement of heat moisture exchange filter every 24 hours
Closed suction catheter change every 4 hours
Suctioning every 2 hours or as needed
30 degree semi recumbent positioning protocol when medically feasible
Administration of stress ulcer prophylaxis
Use of an active weaning protocol

Article 2 Breakdown

(American Journal of Critical Care - 48 month study)

Strengths

Two year study


Large control group
Large study/intervention group
Shows link between oral care and ventilator-assisted pneumonia
Conducted from evidence based practice

Quality

Consistency
Compliance
Comparable pt. data

Credibility

American Journal of Critical Care


Peer Reviewed
Comparative Studies Listed

Article Contributes to, and further proves evidence based practice that is currently
being implemented in the ICU

Relevance to Practice

Current Nation Wide Practice


No change necessary

If change is implemented it would be an increase in amount of suctioning and amount of


times oral care is performed per 24 hour period
Further research of the VAP bundle, is oral care as important as the other components of the
VAP bundle?

Communication

Current oral care policy


Educating Staff

Number of times or care performed per 24 hour period


Solutions used for effective oral care
Proper technique for oral care

Relevance to Practice

Potential Barriers

Compliance by staff
Can patient tolerate oral care?
Funding
Timing/frequency of oral care
Not large studies

Other PICO Questions

When a patient is on the mechanical ventilator, how does oral care compare to the
other ventilator-associated pneumonia bundle components in preventing ventilatorassociated pneumonia?
In patients on the mechanical ventilator, how does the effectiveness of oral care
compare to patients of different ages?
In a patient who is on the mechanical ventilator, how does the implementation of the
ventilator-assisted pneumonia bundle effect length of patient stay compared to a
patient who does not receive the ventilator-assisted pneumonia bundle?

Conclusion
Proper oral care reduces the occurrence of Ventilator- Associated
Pneumonia
Oral care along with the Ventilator-Associated Pneumonia bundle
decrease occurrence
Reduced cost for hospital by preventing Ventilator-Associated
Pneumonia
Decrease length of hospital stay
Two of many evidence based practice studies proving importance of
oral care