COMPREHENSIVE ORAL CARE IS ASSOCIATED WITH A SIGNIFICANT DECREASE IN VENTILATOR-ASSOCIATED PNEUMONIA: A SINGLE CENTER PROSPECTIVE COHORT STUDY.

BACKGROUND

Mechanically ventilated patients in the intensive care unit (ICU) are at risk for developing ventilator-associated pneumonia (VAP), with a 13% mortality rate and cost of $50,000 per patient. Toothbrushing is associated with positive outcomes, including lower VAP rates. Electric toothbrushes (eTBs) have greater effectiveness in the general population compared with manual toothbrushes (mTBs), and eTBs may provide benefits to ventilated patients.

OBJECTIVE

The aim of the study was to evaluate VAP rates for patients receiving a comprehensive oral care protocol (COCP) including an eTB versus a standard oral care protocol (SOCP) including an mTB.

METHODS

We conducted a prospective cohort study in a tertiary hospital's ICUs. SOCP or COCP consisting of an electric toothbrush was followed. VAP rates and hospital costs were compared between groups.

RESULTS

Our study included 72 ICU patients (63.9% male, mean age 53.5±16.6 years). Patients treated with COCP were less likely to develop VAP (2.6% vs 21.2%, P=0.020), had significantly fewer ventilation days (5.4±1.8 vs 6.2±1.3, P=0.031), and fewer ICU days (9.0±5.6 vs 13.8±9.1, P=0.012). The COCP group had significantly fewer VAPs per 1,000 patient ventilation days, 1 in 209 days, or 4.8 (0.1-26.7) events per 1,000 ventilation days versus standard oral care with 7 in 190 days or 36.8 (14.8-75.9), P=0.037. Cost savings if COCP would have been used in the SOCP group of 33 patients were estimated at $283,428.

CONCLUSION

We compared standard versus comprehensive oral care protocols. Significantly fewer patients treated with the comprehensive protocol developed VAP and hospital savings were significant.