Oral Care with Chlorhexidine

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Oral Care with Chlorhexidine Ventilator Bundle and Oral Care Procedures Ventilator Associated Pneumonia (VAP) is a healthcare acquired infection of concerning risk to patients who require mechanical ventilation. In fact, VAP is the most common nosocomial infection in patients who are mechanically ventilated (Barclay & Vega, 2005). The American Association of Critical Care Nurses (AACN) has recommended steps for the reduction of VAP and, when implemented together, are referred to as the “Ventilator Bundle”. These steps are based on best practice guidelines from the Centers for Disease Control and Prevention (CDC) and include head of bed elevation 30 to 45 degrees, continuos removal of subglottic secretions, change of ventilator circuit no more than every 48 hours and washing of hands before and after patient contact (AACN, 2008). In The Guidelines for Preventing Health Care Associated Pneumonia, 2003 the Centers for Disease Control and Prevention (CDC) also makes a key recommendation for the development of oral hygiene programs that may include the use of an oral antiseptic agent (CDC, 2004). Oral Care Procedure in Need of Change While oral care is present in many critical care unit’s ventilator policies and used in conjunction with the ventilator bundle, there is wide variance. In a 2007 cross sectional survey of critical nurses, 50% reported having oral care protocols in place within their hospitals but revealed variances in practices (Cason, Tyner, Saunders & Broome, 2007). In 2005 Peace Health St, Joseph’s Medical Center, a 243 bed rural hospital in Bellingham, WA formed a comprhensive ventilaor bundle that included oral care. The basis for the practice was determined by a multidisciplnary team that was formed to... ... middle of paper ... ...xidine. Retrieved from http://www.ihi.org/knowledge/Pages/Changes/DailyOralCarewithChlorhexidine.aspx IHI. (2011). Ventilator bundle. Retrieved from http://www.ihi.org/offerings/MembershipsNetworks/MentorHospitalRegistry/Pages/VentilatorBundle.aspx Koeman, M., AJA, Hak, E., Joore, H., Kaasjager, K., de Smet, A., &, ... Bonten, M. (2006). Oral decontamination with chlorhexidine reduces the incidence of ventilator- associated pneumonia. American Journal Of Respiratory & Critical Care Medicine, 173(12), 1348-1355. Munro, C., Grap, M., Jones, D., McClish, D., & Sessler, C. (2009). Chlorhexidine, toothbrushing, and preventing ventilator-associated pneumonia in critically ill adults. American Journal Of Critical Care, 18(5), 428-438. doi: 10.4037/ajcc2009792. Valente, T. (2002). Evaluating Health Promotion Programs. New York: Oxford University Press.
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