Nosocomial Pneumonia—Oral Care as Part
of a Ventilator Associated Pneumonia Prevention Effort
Nosocomial pneumonia presents a complex treatment challenge for healthcare
professionals which increases risk of morbidity and mortality for patients
in all healthcare settings, from acute to long term care. The impact of
nosocomial pneumonia includes:
- increased length of stay
- increased patient care intensity for staff
- higher facility resource utilization levels
- substantially increased healthcare costs
Ventilated patients are
particularly at risk for nosocomial pneumonia and Ventilator-Associated
- Ventilated patients are at higher risk for pneumonia due to
aspiration of oral secretions related to endotracheal intubation(1)
- VAP can occur in greater than 10% of ventilated patients.(2,3)
- Hospital Associated Pneumonia (HAP) potential increases with
length of mechanical ventilation by 6-21 times(1)
Recent studies have found that
a number of patient care measures,
including oral hygiene, can help reduce pneumonia rates. Oral
hygiene has been determined
be important as:
- the oral cavity can be colonized with pathogens that can lead
to nosocomial pneumonia and VAP.(2, 4, 5)
- dental plaque can be a critical reservoir for these bacteria.
- Studies have shown a 60% reduction in VAP rates after implementation
of a comprehensive oral care program.(8)
- Patients in long-term care settings are at increased risk of
Community Acquired Pneumonia (CAP) due to aspiration of oral secretions
from dysphagia caused by stroke, Alzheimer’s disease, Parkinson’s
disease and other conditions.(9,10)
Formal oral care protocols
have been shown to play an important role in reducing nosocomial pneumonia,
including VAP, by reducing
dental plaque and
in the oral cavity through routine brushing and cleaning of
These findings led to the CDC Guidelines for Preventing Healthcare-Associated
2003, which recommends that healthcare facilities “develop and implement
a comprehensive oral-hygiene program” to reduce pneumonia rates.
- CDC. Guidelines for Preventing Healthcare Associated Pneumonia, 2003
Recommendations of CDC and the Healthcare Infection Control
Practices Advisory Committee, 2003.
- Sole ML, et al. Bacterial
Growth in Secretions and on Suctioning Equipment of Orally
Intubated Patients. Am J Crit Care. 2002 Mar;11(2):141-9.
EH, Tracy L, et al. The Occurrence of Ventilator-Associated
Pneumonia in a Community Hospital. Chest 2001; 120:555-561.
C, Furr LA, et al. Survey of Oral Care Practices in US Intensive
Care Units. Am J Infect Control
- Munro CL, et al. Oral Health and Care
in the Intensive Care Unit; State of the Science.
Am J Crit Care. 2004 Jan;13(1):25-33.
F, Duvivier B, et al. Colonization of Dental Plaque: A Source
of Nosocomial Infection in ICU Patients. Crit
Care Med 1998; 26:301-308.
- El-Solh AA,
Peitrantoni C, et al. Colonization of Dental Plaques:
A Reservoir of Respiratory Pathogens
for Hospital-Acquired Pneumonia in Institutionalized
Elders. Chest 2004;126:1575-1582.
B, Stott, K. The Effect of a Comprehensive
Oral Care Protocol on Patients
at Risk for Ventilator-Associated Pneumonia. J Advocate
Health Care. Spr/Sum 2002;4(1):27-30.
PR. Pneumonia in the Long Term
Care Setting: Etiology,
Management and Prevention. J Gerontol Nurs.
PE, Kaplan D. Aspiration
Pneumonia and Dysphagia in the Elderly.
J, et al. Epidemiology and Outcomes of Ventilator Associated
Pneumonia in a
Large U.S. Database. Chest 2002 122: 2115-2121.