Decreasing Ventilator-associated Pneumonia

Laux, Lori; Herbert, Cheryl

doi:10.1097/00002727-200607000-00011

Cited by 8 publications

(3 citation statements)

References 3 publications

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“…Reduction of bacterial number by topical treatment therefore may be an attractive therapeutic choice for patients at high risk. For instance, use of chlorhexidine gluconate in the early post-intubation period was shown to mitigate or delay the development of ventilator-associated pneumonia [8,60-63]. Further, treatment of mechanically ventilated patients with a daily oral hygiene consisting of an 0.12% chlorhexidine gluconate wash reduced the risk for nosocomial pneumonia [63-65].…”

Section: Discussionmentioning

confidence: 99%

Role of pathogenic oral flora in postoperative pneumonia following brain surgery

et al. 2009

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BackgroundPost-operative pulmonary infection often appears to result from aspiration of pathogens colonizing the oral cavity. It was hypothesized that impaired periodontal status and pathogenic oral bacteria significantly contribute to development of aspiration pneumonia following neurosurgical operations. Further, the prophylactic effects of a single dose preoperative cefazolin on the oral bacteria were investigated.MethodsA matched cohort of 18 patients without postoperative lung complications was compared to 5 patients who developed pneumonia within 48 hours after brain surgery. Patients waiting for elective operation of a single brain tumor underwent dental examination and saliva collection before surgery. Bacteria from saliva cultures were isolated and periodontal disease was scored according to type and severity. Patients received 15 mg/kg cefazolin intravenously at the beginning of surgery. Serum, saliva and bronchial secretion were collected promptly after the operation. The minimal inhibitory concentrations of cefazolin regarding the isolated bacteria were determined. The actual antibiotic concentrations in serum, saliva and bronchial secretion were measured by capillary electrophoresis upon completion of surgery. Bacteria were isolated again from the sputum of postoperative pneumonia patients.ResultsThe number and severity of coexisting periodontal diseases were significantly greater in patients with postoperative pneumonia in comparison to the control group (p = 0.031 and p = 0.002, respectively). The relative risk of developing postoperative pneumonia in high periodontal score patients was 3.5 greater than in patients who had low periodontal score (p < 0.0001). Cefazolin concentration in saliva and bronchial secretion remained below detectable levels in every patient.ConclusionPresence of multiple periodontal diseases and pathogenic bacteria in the saliva are important predisposing factors of postoperative aspiration pneumonia in patients after brain surgery. The low penetration rate of cefazolin into the saliva indicates that its prophylactic administration may not be sufficient to prevent postoperative aspiration pneumonia. Our study suggests that dental examination may be warranted in order to identify patients at high risk of developing postoperative respiratory infections.

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Section: Discussionmentioning

confidence: 99%

Role of pathogenic oral flora in postoperative pneumonia following brain surgery

et al. 2009

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“…As reported in several studies, the VAP incidence can be substantially prevented by implementing basic VAP interventions such as hand hygiene [20], semirecumbent positioning [21], and daily rinsing of the mouth with chlorhexidine [18]. To improve compliance, we will continue to strengthen education and training, and communication and monitoring.…”

Section: Discussionmentioning

confidence: 96%

Impact of a multidimensional approach on ventilator-associated pneumonia rates in a hospital of Shanghai: Findings of the International Nosocomial Infection Control Consortium

Tao¹,

Hu²,

Rosenthal³

et al. 2012

Journal of Critical Care

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“…7,11 The Agency for Healthcare Research and Quality National Guideline Clearinghouse recommends performing regular antiseptic oral care in accordance with manufacturer guidelines as its strongest evidence. 20 Care includes dating of the package when opened and routine change-out of the Yankauer every 24 hours. 19 It is important to note that if chlorhexidine swabbing is contraindicated, toothbrushing every shift is effective in the reduction of VAP.…”

Section: Chlorhexidine Toothbrushing and Tonsil-tip Suctionmentioning

confidence: 99%

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Browne

Evans

Christmas

et al. 2011

Critical Care Nursing Quarterly

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Oral hygiene in seriously ill patients is a nursing responsibility. Oral hygiene regimens in conjunction with standardized ventilator-associated pneumonia "bundles" reduce the incidence of pneumonia, length of stay, and associated costs in critical care. Following strict adherence to the recommended ventilator-associated pneumonia bundle, the ventilator-associated pneumonia rate at the Northeast Baptist Hospital intensive care units has remained 0% for 36 months. Oral care in this patient population, however, has remained vague based on ritual and nurse preference. This article describes the development of an oral care protocol based on best evidence, providing a rationale for standardization of oral hygiene and the plan for surveillance and updating.

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Decreasing Ventilator-associated Pneumonia

Cited by 8 publications

References 3 publications

Role of pathogenic oral flora in postoperative pneumonia following brain surgery

Role of pathogenic oral flora in postoperative pneumonia following brain surgery

Impact of a multidimensional approach on ventilator-associated pneumonia rates in a hospital of Shanghai: Findings of the International Nosocomial Infection Control Consortium

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