Jérôme Ory1, Evelyne Raybaud1, Russell Chabanne2, Bernard Cosserant3, Jean Sébastien Faure4, Renaud Guérin5, Laure Calvet6, Bruno Pereira7, Charline Mourgues8, Dominique Guelon4, Ousmane Traore9. 1. Hygiène Hospitalière, CHU Clermont-Ferrand, Clermont-Ferrand, France. 2. Réanimation Neurochirurgicale, CHU Clermont-Ferrand, Clermont-Ferrand, France. 3. Réanimation Cardio Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France. 4. Réanimation Médico-Chirurgicale Gabriel Montpied, CHU Clermont-Ferrand, Clermont-Ferrand, France. 5. Réanimation Médico-Chirurgicale Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France. 6. Réanimation Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France. 7. Bio-statistiques Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France. 8. Santé Publique, CHU Clermont-Ferrand, Clermont-Ferrand, France. 9. Hygiène Hospitalière, CHU Clermont-Ferrand, Clermont-Ferrand, France. Electronic address: otraore@chu-clermontferrand.fr.
Abstract
BACKGROUND: The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. MATERIAL/ METHODS: This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. RESULTS: A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). CONCLUSIONS: Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.
BACKGROUND: The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. MATERIAL/ METHODS: This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. RESULTS: A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). CONCLUSIONS: Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates.