Oral Care for Critically Ill

patients: A Quality
Improvement Initiative
Presented by:
Kakra Agyen
Kristen Ewing
Rachel Quinn
Sabrina Rule
University of South Florida
College of Nursing
Introduction
WHY is oral hygiene important?
Poor oral health
gingivitis (inflammation)
Change in the oral structures
periodontal disease
Aspiration of bacteria and
microorganisms1
 Issue
Ventilator-associated pneumonia (VAP) is defined as pneumonia in a
patient intubated and ventilated at the time of or within 48 hours before
the onset of the event. 3
2nd most common nosocomial infection 4
Close to 50% mortality rate 3
Less than 44% of critical care nurses report brushing teeth 5
 Proposed Change
Oral Care Focus

Toothbrush vs Sponge Brush

Nurses concerned about ICP
Pendergast study

Electric toothbrush, tongue scraper,

moisturizer

Oral care 2x daily

Assessment by Nurse

Oral care can be delegated to PCT

PLAN
Provide an inservice to the
hospital floor staff
Explain roles and responsibilities
Nurse
PCT
Order necessary materials
Integrate into flow of day
Provide designated section for
charting
Nurses - Assessment
PCT - performance of oral care
Monitor patient results and
toleration
Examine the resulting rates of
VAP
 DO

Carry out the plan

NURSE: perform an oral assessment beginning of shift and
plan care accordingly
PCT: oral care and document completion

Nurses must reassess throughout day + make

sure oral care by PCT is carried out + document
completion
STUDY

Data collection
64 hospitals
23 states from Florida to California
Hospitals reported data via surveys
Documentation was reviewed

The results of the study were similar to our predictions

The rates of VAP decreased by 35%
The mortality rates of VAP were lower by 50% after the oral care was
implemented
ACT
Training sessions

Equipment will be provided to all appropriate units

New charting section

Charge nurse responsibilities

Feedback sessions for the first six months

 REFERENCES
1. American Academy of Periodontology. (2011). Healthy gums may lead to healthy lungs.
Retrieved from https://www.perio.org/consumer/healthy-lungs
2. Booker,S., Murff, S., Kitko, L., & Jablonski, R. (2013). Mouth care to reduce ventilator associated
pneumonia. American Journal of Nursing, 113(10), 24-30. doi:
10.1097/01.NAJ.0000435343.38287.3a
3. Institute for Healthcare Improvement. (n.d.). Ventilator-Associated Pneumonia (VAP) Rate per
1,000 Ventilator Days. Retrieved June 21, 2017, from
http://www.ihi.org/resources/Pages/Measures/VentilatorAssociatedPneumoniaRateper1000V
entilatorDays.aspx
4. Richards, M., Edwards, J. R., Culver, D. H., & Gaynes, R. P. (1999, May). Nosocomial infections in
medical intensive care units in the United States. National Nosocomial Infections Surveillance
System. Critical Care Medicine, 27(5).
5. Pendergast, V., & Kleiman, C. (2015). Interprofessional Practice: Translating Evidence-Based
Oral Care to Hospital Care. Journal of Dental Hygiene, 89, 33-35. Retrieved June 21, 2017.