Transcript The Importance of Clinical Oral Care

The Importance of
Clinical Oral Care
Hospital-Acquired Pneumonia
(HAP)
• Oral cavity plays key role
in HAP development
• Includes ventilatorassociated pneumonia (VAP)
Scannapieco FA, et al., J Periodontology. 1999; 70(7); 793-802.
Hospital-Acquired Pneumonia
(HAP)
• Defined as: Pneumonia that occurs 48
hours or more after admission, that was
not incubating at the time of admission.
– American Thoracic Society
Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005
Hospital-Acquired Pneumonia
(HAP)
• Rate of between 5 and 10 cases per 1,000
hospital admissions
• Incidence of HAP increases by 6-20 fold in
vented patients
• Accounts for up to 25% of all ICU infections
• Nearly 90% of ICU HAP episodes occur
during mechanical ventilation
Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005
Ventilator-Associated Pneumonia
(VAP)
• Defined as: Pneumonia that arises more
than 48-72 hours after endotracheal
intubation.
– American Thoracic Society
Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005
Ventilator-Associated Pneumonia
(VAP)
• VAP has a high mortality rate and extends
length of stay1
• Mean hospital costs range between $40,0002
and $150,00 per episode3
• Approximately half of all VAP episodes occur
during the first 4 days of hospitalization1
1. Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005
2. Kollef MH, et al., Chest. Dec 2005;128(6) ):3854-62
High Mortality
• Hospital-associated pneumonias
• Fatal for 20 to 33% of patients
Source: Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, CDC/HICPACL 8-9.
High Mortality, Longer Stays,
Increased Costs
HAP
18.8%
VAP
29.3%
Length of Stay
15.2 days
23 days
Mean Hospital
Charges
$65,292
$150,841
Mortality
Kollef MH, et al., Chest. Dec 2005;128(6):3854-62.
VAP=Longer Stays
• 9.6 more days on the Vent
• 6.1 more days in the ICU
• 11.5 more days in the Hospital
Rello J. et al., Chest. Dec 2002; 122(6): 2115-21
VAP=Increased Costs
• > $40,000 per case to treat
• Facility pays the bill
Rello J. et al., Chest. Dec 2002; 122(6): 2115-21
ORAL CARE: SUCTION and
NON-SUCTION
90%
80%
Annual 2011 Market
70%
60%
50%
40%
30%
20%
10%
0%
89.2%
6.6%
3.9%
* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries,
0.3%
0.1%
<0.1%
each
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital;
Annual market represents last 4 quarters of data
ORAL CARE: SUCTION
90%
80%
Annual 2011 Market
70%
60%
50%
40%
30%
20%
10%
0%
89.6%
6.7%
3.5%
.2%
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital;
Annual market represents last 4 quarters of data
ORAL CARE: NON-SUCTION
90%
80%
Annual 2011 Market
70%
60%
50%
40%
30%
20%
10%
0%
84.5%
5.9%
5.5%
* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries, Tri-State, PDI
<1.1%
each
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital;
Annual market represents last 4 quarters of data
Market Review – VAP Prevention
Q-Care Units
~ 2.1 M Days
28.5%
Q-Care Petite
~ 73.7 K Days
Vent Days*
(Adult and Pediatric)
~7.4 M Days
Available Market:
70.5%
*Source: Principal Procedure outcomes for respiratory intubation and ventilation: Healthcare
Cost and Utilization Project (HCUP), 2006, http://hcupnet.ahrq.gov/; Q-Care Sales figures: Sage Sales from
September 2007 – August 2008
1%
The Effect of a Comprehensive Oral Care Protocol on
Patients at Risk for VentilatorAssociated Pneumonia
• Implemented a
comprehensive
oral care program
• Reduced VAP
by 60%
Schleder B. et al., J Advocate Health Care. 2002
CDC Guidelines
References Schleder’s work...
“...Develop and implement
a comprehensive
oral-hygiene program…”.
Source: Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, CDC/HICPAC:8-9.
AACN News Robert Garcia BS,
MMT(ASCP),CIC
• Implemented a
comprehensive oral care
program
• Reduced VAP’s by
42.1%
• Avoided cost $722,975
• Statistically Significant
Vollman K, Garcia R, AACN News, August 2005, Volume 22, No. 8.
Three of the VAP Risk Factors
1) Bacterial colonization of the
oropharyngeal area
2) Aspiration of subglottic secretions
(routine suctioning minimizes oral
secretions that can migrate to the
subglottic area.)
3) Colonization of dental plaque with
respiratory pathogens
Schleder B. et al., J Advocate Health Care. 2002
Evidence-Based Protocol
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Assessment
Cleaning
Debriding
Suctioning
Moisturizing
AACN Procedure Manual for
Critical Care
“In addition to brushing twice daily, use oral swabs with 1.5%
hydrogen peroxide solution to clean mouth every 2 to 4 hours. With
each cleansing, apply a mouth moisturizer to the oral mucosa and lips
to keep tissue moist”
• Q12 Brushing
• Q2-Q4 Swabbing
• Moisturize after each cleaning
Customize Your Protocol
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