Research Rounds: Brushing away ventilator-associated pneumonia
Barbara B. Brewer PhD, MBA, RN, MALS
Alisa Domb BSN, RN
Roberta Johnson MN, RN, CCRN
Kari Zimmerman MSN, RN, ACNS-BC

$1.99 		Nursing2013 Critical Care
July 2011 
Volume 6  Number 4
Pages 7 - 11
 
  PDF Version Available!

ABSTRACT
Ventilator-associated pneumonia (VAP) is the second most common healthcare-associated infection (HAI) in the United States and the most frequently occurring HAI among mechanically ventilated patients.1,2 Pneumonia is one of the most common HAIs in hospitalized patients, and the CDC and Healthcare Infection Control Practices Advisory Committee strongly recommend surveillance for bacterial pneumonia in mechanically ventilated patients to identify trends and improve outcomes.3 With a reported incidence of 5 to 10 cases per 1,000 hospital admissions, VAP has been associated with extending hospital stays by 1 week, increasing healthcare costs by $40,000 per affected patient, and increasing morbidity and mortality.2Colonization of the oropharynx is one of the most critical risk factors for VAP development.4-13 Potentially pathogenic bacteria, including those responsible for VAP, can grow in dental plaque. In critically ill patients, potential pathogens have been cultured from the oral cavity; these microorganisms can translocate and colonize the lung, resulting in VAP. The CDC, American Association of Critical-Care Nurses, and Institute for Healthcare Improvement recommend that a comprehensive oral hygiene program be developed and implemented to provide oropharyngeal cleaning and decontamination, with or without an antiseptic agent.14 VAP has become such a quality problem that it was recently added to the outcome indicators in the National Database of Nursing Quality Indicators.3A variety of oral hygiene methods have been identified, including chlorhexidine, antibacterial rinse, foam swabs, and toothbrushing. These methods each have a variable effect on VAP reduction.VAP has been reduced in cardiac surgery patients who received chlorhexidine preoperatively.8,9,15 Postintervention results in an observational study among surgical ICU patients requiring mechanical ventilation found a 46% reduction in VAP (to 2.4 cases per 1,000 ventilator days) when 15 mL of a 0.12% chlorhexidine

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