Timelines of Oral Care and Early-Onset Ventilator Associated Pneumonia Prevention
Hospital-acquired infections, including ventilator associated pneumonia (VAP), are a significant cause of morbidity and mortality and associated with increased costs and length of stay (Chastre & Fagon, 2002; NNIS, 2004). Ventilator associated pneumonia is believed to primarily result from aspiration of oropharyngeal secretions around the endotracheal tube cuff into the lungs (Grap, Munro, Unoki, Hamilton, & Ward, 2012). A randomized control trial tested early application of oral chlorhexidine (CHG) on oral microbial flora and VAP in trauma patients and suggested that early (within 12 hours of intubation) application may reduce VAP rates in trauma patients (Grap, Munro, Hamilton, Elswick, Sessler & Ward, 2011). The VAP rate in a local Level 1 trauma center, 11-bed trauma intensive care unit (TICU) was 8.7 per 1000 device days, above the national average (NHSN, 2011). The purpose of this research was to explore the relationship between the time of insertion of an endotracheal tube and first CHG application and early onset (within 72 hours of intubation) VAP. A retrospective chart review of the records of randomly selected adult intubated trauma patients hospitalized on the TICU was conducted. Collected data included: time of intubation; timing of CHG application; VAP occurrences; and length of intubation. Less than half (45.8%) of patients received early CHG application, and most (79.2%) were intubated in the emergency department (ED), suggesting that VAP prevention measures begin in the ED. Of the patients reviewed, five developed VAP; three occurred in patients who had received oral CHG within 12 hours of intubation. A CNS-driven collaboration with other disciplines and departments is essential to implement VAP prevention measures and provide comprehensive, quality care.