Post on 18-Dec-2015
The Importance of Clinical Oral Care
Hospital-Acquired Pneumonia (HAP)
• Oral cavity plays key role
in HAP development
• Includes ventilator-
associated pneumonia (VAP)
Scannapieco FA, et al., J Periodontology. 1999; 70(7); 793-802.
• Defined as: Pneumonia that occurs 48 hours or more after admission, that was not incubating at the time of admission.
– American Thoracic Society
Hospital-Acquired Pneumonia (HAP)
Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005
• 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
Hospital-Acquired Pneumonia (HAP)
• 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, 20052. Kollef MH, et al., Chest. Dec 2005;128(6) ):3854-62
Ventilator-Associated Pneumonia (VAP)
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
Mortality
Length of Stay
Mean HospitalCharges
VAP
29.3%
23 days
$150,841
HAP
18.8%
15.2 days
$65,292
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
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries,
ORAL CARE: SUCTION and ORAL CARE: SUCTION and NON-SUCTIONNON-SUCTION
ORAL CARE: SUCTION and ORAL CARE: SUCTION and NON-SUCTIONNON-SUCTION
Medlin
eM
edlin
e
Kimberly
-
Clark
/
BallardKim
berly-
Clark
/
Ballard
Sage
Sage
Tradem
ark
Medica
lTra
demark
Medica
l
Others
*
Others
*
89.2%89.2%89.2%89.2% 6.6%6.6%6.6%6.6% 3.9%3.9%3.9%3.9% 0.3%0.3%0.3%0.3% 0.1%0.1%0.1%0.1% <0.1% <0.1% eacheach<0.1% <0.1% eacheach
Annual 2011 MarketAnnual 2011 Market
Tri-Sta
te
Medica
lTri-
State
Medica
l
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
ORAL CARE: SUCTIONORAL CARE: SUCTIONORAL CARE: SUCTIONORAL CARE: SUCTION
Medlin
eM
edlin
e
Kimberly
-
Clark
/
BallardKim
berly-
Clark
/
Ballard
Tradem
ark
Medica
l
Tradem
ark
Medica
l
SageSage
89.6%89.6%89.6%89.6% 6.7%6.7%6.7%6.7% 3.5%3.5%3.5%3.5% .2%.2%.2%.2%
Annual 2011 MarketAnnual 2011 Market
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries, Tri-State, PDI
ORAL CARE: NON-SUCTIONORAL CARE: NON-SUCTIONORAL CARE: NON-SUCTIONORAL CARE: NON-SUCTION
Medlin
eM
edlin
e
Kimberly
-
Clark
/
BallardKim
berly-
Clark
/
Ballard
SageSage
Others
*
Others
*
84.5%84.5%84.5%84.5% 5.9%5.9%5.9%5.9% 5.5%5.5%5.5%5.5% <1.1% <1.1% eacheach<1.1% <1.1% eacheach
Annual 2011 MarketAnnual 2011 Market
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%
Vent Days* (Adult and Pediatric)
~7.4 M Days Available Market:
70.5%
Q-Care Petite
~ 73.7 K Days
1%
*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
The Effect of a Comprehensive Oral Care Protocol on Patients at Risk for Ventilator-
Associated 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
• 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
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