The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

EVALUATION OF A COLLABORATIVE ORAL CARE PROCESS AND ITS EFFECT ON VENTILATOR ASSOCIATED PNEUMONIA RATES.

Sara Bunting1, Amy Wise1



Background: The Voluntary Hospitals of America (VHA) Transition of the Intensive Care Vent Bundle was initiated in January 2005 in the Neurology/Trauma Intensive Care. As an organization, we implemented a Ventilator Associated Pneumonia (VAP) prevention team in conjunction with the Vent Bundle. Prior to this oral care was done through a protocol process and was primarily a nursing responsibility.

Methods: The VAP team required active involvement from respiratory therapy (RT) in the prevention of VAP. Education was completed with a focus on diligent oral care and RT collaboration with nursing. Oral care consists of 3 separate physical elements: tooth brushing, oral membrane moistening, and subglottic suctioning. These elements provide a Q2 oral care program on patients with an artificial airway. Under this approach nursing and RT alternate responsibility every 2 hours, providing the standard Q2 hour care. Data were collected from random oral care audits performed from January 2006 through March 2008. VAP rate data were calculated per 1000 ventilator days from May 2005 through April 2008.

Results: Since the implementation of Q2 oral care with shared responsibility between RT and nursing as well as the start of chlorhexidine gluconate, VAP rates have decreased. A declining trend line reveals that increased oral care compliance along with chlorhexidine gluconate has a direct effect on the outcome of our patients. The graphs note achievements and compliance as they coincide with VAP rates.

Conclusion: Respiratory therapy and nursing are working together to provide diligent oral care to patients with artificial airways. This dedicated team has taken ownership in their role fighting for VAP extinction. We will continue to evaluate VAP prevention strategies, audit oral care compliance, and track VAP rates within the organization, ultimately striving for a goal of 0%. We hope this presentation provides your organization the ability and encouragement to implement a successful VAP prevention program.