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Darbanian N, Nobahar M, Ghorbani R. Effect of propolis mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial. BMC Oral Health 2024; 24:636. [PMID: 38811949 PMCID: PMC11137970 DOI: 10.1186/s12903-024-04412-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/24/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVES Ventilator-associated pneumonia (VAP) increases the length of hospitalization and mortality rate. This study aimed to determine the effect of propolis mouthwash on the incidence of VAP in intensive care unit (ICU) patients. MATERIALS AND METHODS Triple-blind, comparative randomized, controlled clinical trial was conducted over one year, with 110 ICU patients at Imam-Hossein and Bahar hospitals (Shahroud) and Kowsar Hospital (Semnan) in Iran. The intervention group used 15 cc of 0.06% propolis mouthwash solution twice daily at 8 AM and 4 PM for seven days. The control group used 15 cc of 0.2% chlorhexidine mouthwash at the same times and duration. Data were collected using a demographic questionnaire, APACHE II, Beck Oral Assessment Scale, and Modified Clinical Pulmonary Infection Score (MCPIS). RESULTS There was no significant difference in demographic information, disease severity, and oral health between the two groups before and after intervention (P > 0.05). The incidence of VAP in the intervention group compared to the control group was 10.9% vs. 30.9% on the third day (P = 0.0166, 95% CI: 0.53-0.83 and RR = 0.35), 23.6% vs. 43.6% on the fifth day (P = 0.0325 and 95% CI: 0.31-0.95 and RR = 0.54), and 25.5% vs. 47.3% on the seventh day (P = 0.0224, 95% CI: 0.32-0.92, and RR = 0.54). The Mann-Whitney indicated the incidence of VAP was significantly lower in the intervention group on the third, fifth, and seventh days. CONCLUSION Propolis mouthwash can be considered as an alternative to chlorhexidine mouthwash for ICU patients. CLINICAL RELEVANCE Propolis mouthwash serves as a simple, economical intervention to potentially reduce incidence of VAP. TRIAL REGISTRATION (IRCT20110427006318N12, date 02.04.2019).
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Affiliation(s)
- Nayereh Darbanian
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Monir Nobahar
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran.
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Epidemiology and Biostatistics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Núñez MDRR, Engel FD, Cardoso M, Castro RG, Montoya JAG, de Mello ALSF. Oral hygiene prior to cardiac surgery to prevent infections: Randomized clinical trial. Int J Dent Hyg 2024; 22:384-393. [PMID: 36546871 DOI: 10.1111/idh.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT It is not clear if an oral hygiene protocol to control biofilm applied before cardiac surgery can reduce infection rates. OBJECTIVE We aim to verify the effectiveness of an oral hygiene protocol in reducing postoperative infections when compared to usual practices, in patients admitted to a cardiology unit, prior to cardiac surgery. DESIGN, SETTING AND PARTICIPANTS Randomized, blind, controlled clinical trial, with 107 participants who expected to undergo cardiac surgery, randomized into two groups: Experimental Group (EG) standardized oral hygiene protocol (54) and Control Group (CG), usual practices performed in patients admitted (53). INTERVENTION a standardized oral hygiene protocol, 1 day before surgery: professional prophylaxis with a portable ultrasound device, tooth brushing and flossing plus a 0.12% chlorhexidine gluconate solution (0.12% CHX) mouth rinsing. When applicable, removable prostheses cleaning. PRIMARY OUTCOME the presence of infection. RESULTS The occurrence of postoperative infection was higher in CG = 7 (13.2%) than in EG = 5 (9.3%); but no statistical difference was found between protocols (p = 0.518). The length of stayed from surgery to discharge presented a statistical difference (p = 0.047; RR = 4.9; CI = 1.01-24.33); the percentage of postoperative infection was almost five times higher in those participants who stayed 11 or more days. CONCLUSION The standardized oral hygiene protocol with mechanical and chemical cleaning, 1 day before cardiac surgery, was not more effective than the usual practices performed regarding the reduction of postoperative infections. Other interventions regarding oral hygiene procedures before cardiac surgery must be studied to contribute to the reduction of adverse post-surgical events. CLINICAL TRIAL REGISTRATION Site Ensaclinicos.gov.br number U1111-1214-2862. DESCRIPTORS Healthcare Associated Infections, Cardiovascular Diseases, Periodontal Diseases, Dental Biofilm, Cardiovascular Surgery.
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Ehrenzeller S, Klompas M. Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia: A Systematic Review and Meta-Analysis. JAMA Intern Med 2024; 184:131-142. [PMID: 38109100 PMCID: PMC10728803 DOI: 10.1001/jamainternmed.2023.6638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/11/2023] [Indexed: 12/19/2023]
Abstract
Importance Hospital-acquired pneumonia (HAP) is the most common and morbid health care-associated infection, but limited data on effective prevention strategies are available. Objective To determine whether daily toothbrushing is associated with lower rates of HAP and other patient-relevant outcomes. Data Sources A search of PubMed, Embase, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, and 3 trial registries was performed from inception through March 9, 2023. Study Selection Randomized clinical trials of hospitalized adults comparing daily oral care with toothbrushing vs regimens without toothbrushing. Data Extraction and Synthesis Data extraction and risk of bias assessments were performed in duplicate. Meta-analysis was performed using random-effects models. Main Outcomes and Measures The primary outcome of this systematic review and meta-analysis was HAP. Secondary outcomes included hospital and intensive care unit (ICU) mortality, duration of mechanical ventilation, ICU and hospital lengths of stay, and use of antibiotics. Subgroups included patients who received invasive mechanical ventilation vs those who did not, toothbrushing twice daily vs more frequently, toothbrushing provided by dental professionals vs general nursing staff, electric vs manual toothbrushing, and studies at low vs high risk of bias. Results A total of 15 trials met inclusion criteria, including 10 742 patients (2033 in the ICU and 8709 in non-ICU departments; effective population size was 2786 after shrinking the population to account for 1 cluster randomized trial in non-ICU patients). Toothbrushing was associated with significantly lower risk for HAP (risk ratio [RR], 0.67 [95% CI, 0.56-0.81]) and ICU mortality (RR, 0.81 [95% CI, 0.69-0.95]). Reduction in pneumonia incidence was significant for patients receiving invasive mechanical ventilation (RR, 0.68 [95% CI, 0.57-0.82) but not for patients who were not receiving invasive mechanical ventilation (RR, 0.32 [95% CI, 0.05-2.02]). Toothbrushing for patients in the ICU was associated with fewer days of mechanical ventilation (mean difference, -1.24 [95% CI, -2.42 to -0.06] days) and a shorter ICU length of stay (mean difference, -1.78 [95% CI, -2.85 to -0.70] days). Brushing twice a day vs more frequent intervals was associated with similar effect estimates. Results were consistent in a sensitivity analysis restricted to 7 studies at low risk of bias (1367 patients). Non-ICU hospital length of stay and use of antibiotics were not associated with toothbrushing. Conclusions The findings of this systematic review and meta-analysis suggest that daily toothbrushing may be associated with significantly lower rates of HAP, particularly in patients receiving mechanical ventilation, lower rates of ICU mortality, shorter duration of mechanical ventilation, and shorter ICU length of stay. Policies and programs encouraging more widespread and consistent toothbrushing are warranted.
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Affiliation(s)
- Selina Ehrenzeller
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Causey C, El Karim I, Blackwood B, McAuley DF, Lundy FT. Quantitative oral health assessments in mechanically ventilated patients: A scoping review. Nurs Crit Care 2023; 28:756-772. [PMID: 35771584 DOI: 10.1111/nicc.12789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/12/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oral health is a key contributor to a person's overall health. Previous studies indicate that oral health deteriorates throughout ventilation and may contribute to the development of ventilator-associated pneumonia (VAP). Oral health at the time of initial ventilation may impact on this deterioration. AIMS To determine the quantitative clinical assessment methods used to measure oral health and what is currently known regarding the oral health of patients at the time of initial ventilation. STUDY DESIGN A systematic literature search using electronic bibliographic databases MEDLINE/PubMed, Embase, CINAHL, and the Cochrane Library was undertaken for this scoping review. Studies were included if patients were >18 years old and mechanically ventilated for <48 h at the time of the first oral assessment. RESULTS In total, 12 studies were included. The review demonstrates a limited understanding of clinical oral health at the time of initial ventilation. Significant variation in both assessment methods and reporting of oral health makes comparison of results difficult resulting in a poor overall understanding of oral health at the time of intubation. CONCLUSION Standardized assessment and reporting methods may improve clinical application of findings and help direct future research. We suggest developing a core outcome set to ensure consistent use of assessment tools as well as standardized reporting of results. RELEVANCE TO CLINICAL PRACTICE It is essential that a good understanding of oral health at the time of initial ventilation is gained so that patients receive more targeted oral hygiene intervention in ICU, potentially leading to improved patient outcomes.
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Affiliation(s)
- Christine Causey
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Ikhlas El Karim
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Daniel F McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
| | - Fionnuala T Lundy
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University, Belfast, UK
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Narbutaitė J, Skirbutytė G, Virtanen JI. Oral care in intensive care units: Lithuanian nurses' attitudes and practices. Acta Odontol Scand 2023:1-6. [PMID: 36597772 DOI: 10.1080/00016357.2022.2163285] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AIM This study examines the attitudes and practices of ICU nurses towards the provision of oral care to their patients. OBJECTIVE We conducted this cross-sectional survey about oral health care practices in ICUs in Lithuania. METHODS We used a self-administered 20-item questionnaire to survey the current oral care practices, training, and attitudes of 108 nurses. The questionnaire was based on previous studies to gather information related to the attitudes, oral care practices, and training of ICU nurses. We used the chi-square test to analyze relationships between the categorical variables. RESULTS Most (88, 82%) of the nurses stated that oral care is important. Although most (83, 77%) had adequate training, a clear majority (98, 91%) of the nurses reported a willingness to learn more. Most (78, 72%) of the nurses found the oral cavity difficult to clean, and (71, 66%) found doing so unpleasant. When performing oral care, the nurses used mostly foam swabs (62, 61%) and moisturizers (54, 53%). More than half (57, 57%) of the nurses expressed a need for more hospital support. CONCLUSIONS Nurses working in ICUs reported that oral care is a high priority for their patients, but a difficult and unpleasant task. Nurses provided oral care mainly with toothbrushes, foam swabs, and moisturizers.
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Affiliation(s)
- Julija Narbutaitė
- Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gertrūda Skirbutytė
- Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jorma I Virtanen
- Faculty of Medicine, University of Bergen, Bergen, Norway.,Institute of Dentistry, University of Turku, Finland
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Sozkes S, Sozkes S. Use of toothbrushing in conjunction with chlorhexidine for preventing ventilator-associated pneumonia: A random-effect meta-analysis of randomized controlled trials. Int J Dent Hyg 2021; 21:389-397. [PMID: 34687588 DOI: 10.1111/idh.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/19/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The oral cavity with poor hygiene is a reservoir of a complex community of commensal and pathogenic bacteria. Improved oral hygiene (OH) may reduce the incidence of ventilator-associated pneumonia (VAP); however, research on the efficacy of different OH treatments and their potential synergistic effects has remained inconclusive. The objective of this study was to examine whether in patients on mechanical ventilation, using a toothbrushing (T) in conjunction with chlorhexidine (CHX), as opposed to only CHX, reduced the incidence of VAP. METHOD A random-effect meta-analysis of randomized clinical trials, which compare the effect of CHX+T (intervention) with CHX (control) on the risk of VAP, was conducted. The Mantel-Haenszel model was used to determine the mean differences (MD), relative risks (RR) and 95% confidence intervals (CI). RESULTS Seven studies with 1424 patients were included. Oral care with CHX+T reduced the incidences of VAP (RR = 0.67; CI = [0.50, 0.88], p = 0.005) compared with that with CHX alone. The former also reduced the duration of mechanical ventilation (MD = -1.38; CI = [-2.43, -0.33], p = 0.01) and length of stay in the ICU (MD = -1.47; CI = [-2.74, -0.20], p = 0.02), although the risk of ICU mortality did not reduce (RR = 0.87, 95% CI = [0.72, 1.04], p = 0.17). CONCLUSIONS Toothbrushing along with CHX significantly reduced the risk of VAP. Further well-designed randomized controlled trials with a careful focus on the OH are needed to fully establish the advantage of toothbrushing along with CHX for reducing the risk of VAP.
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Affiliation(s)
- Serda Sozkes
- Intensive Care Unit and Reanimation Department, Saglik Bakanligi Istanbul Catalca Ilyas Cokay Public Hospital, Istanbul, Turkey
| | - Sarkis Sozkes
- CMF Biomedical Engineering Biomaterials Department, Tekirdag Namik Kemal University, Tekirdag, Turkey
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Haning C, Makic MBF. Toothbrushing for Dependent Neurological Patients in the Intensive Care Unit. Crit Care Nurse 2021; 40:72-76. [PMID: 32476031 DOI: 10.4037/ccn2020445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cailly Haning
- Cailly Haning was a critical care nurse at the Swedish Medical Center, Englewood, Colorado, at the time of this project implementation
| | - Mary Beth Flynn Makic
- Mary Beth Flynn Makic is a professor in and specialty director of the Clinical Nurse Specialist Program at the University of Colorado College of Nursing, Aurora, Colorado, and is a research scientist at Denver Health, Denver, Colorado
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Troch R, Schwartz J, Boss R. Slow and Steady: A Systematic Review of ICU Care Models Relevant to Pediatric Chronic Critical Illness. J Pediatr Intensive Care 2020; 9:233-240. [PMID: 33133737 DOI: 10.1055/s-0040-1713160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022] Open
Abstract
There is a growing population of children with prolonged intensive care unit (ICU) hospitalization. These children with chronic critical illness (CCI) have a high health care utilization. Emerging data suggest a mismatch between the ICU acute care models and the daily care needs of these patients. Clinicians and parents report that the frequent treatment alterations typical for ICU care may be interrupting and jeopardizing the slow recoveries typical for children with CCI. These frequent treatment titrations could therefore be prolonging ICU stays even further. The aim of this study is to evaluate and summarize existing literature regarding pace and consistency of ICU care for patients with CCI. We performed a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (of September 2018). PubMed (biomedical and life sciences literature), Excerpta Medica database (EMBASE), and The Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for English-language studies with data about CCI, care models, and pacing of clinical management. Four unique papers were identified. Our most important finding was that quality data on chronic ICU management, particularly for children, is sparse. All papers in this review confirmed the unique needs of chronic patients, particularly related to respiratory management, which is a common driver of ICU length of stay. Taken together, the papers support the hypothesis that protocols to reduce interdisciplinary management variability and to allow for slower management pacing should be studied for their impact on patient and health system outcomes. Optimizing value in ICU care requires mapping of resources to patient needs, particularly for patients with the most intense resource utilization. For children with CCI, parents and clinicians report that rapid treatment changes undermine recovery and prolong ICU stays. This review highlights the lack of quality pediatric research in this area and supports further investigation of a "slow and steady" approach to ICU management for children with CCI.
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Affiliation(s)
- Rachel Troch
- Department of Neonatology, Children's National Hospital, Washington, District of Columbia, United States
| | - Jamie Schwartz
- Department of Ananthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Renee Boss
- Department of Ananthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Neonatal - Perinatal Medicine, Berman Institute of Bioethics, Baltimore, Maryland, United States
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Sole ML, Talbert S, Yan X, Penoyer D, Mehta D, Bennett M, Emery KP, Middleton A, Deaton L, Abomoelak B, Deb C. Impact of deep oropharyngeal suctioning on microaspiration, ventilator events, and clinical outcomes: A randomized clinical trial. J Adv Nurs 2019; 75:3045-3057. [PMID: 31241194 PMCID: PMC8331062 DOI: 10.1111/jan.14142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 12/12/2022]
Abstract
AIMS To evaluate a deep oropharyngeal suction intervention (NO-ASPIRATE) in intubated patients on microaspiration, ventilator-associated events and clinical outcomes. DESIGN Prospective, two-group, single-blind, randomized clinical trial. METHODS The study was conducted between 2014 - 2017 in 513 participants enroled within 24 hr of intubation and randomized into NO-ASPIRATE or usual care groups. Standard oral care was provided to all participants every 4 hr and deep oropharyngeal suctioning was added to the NO-ASPIRATE group. Oral and tracheal specimens were obtained to quantify α-amylase as an aspiration biomarker. RESULTS Data were analysed for 410 study completers enrolled at least 36 hr: NO-ASPIRATE (N = 206) and usual care (N = 204). Percent of tracheal specimens positive for α-amylase, mean tracheal α-amylase levels over time and ventilator-associated events were not different between groups. The NO-ASPIRATE group had a shorter hospital length of stay and a subgroup with moderate aspiration at baseline had significantly lower α-amylase levels across time. CONCLUSION Hospital length of stay was shorter in the NO-ASPIRATE group and a subgroup of intervention participants had lower α-amylase across time. Delivery of standardized oral care to all participants may have been an intervention itself and possibly associated with the lack of significant findings for most outcomes. IMPACT This trial compared usual care to oral care with a deep suctioning intervention on microaspiration and ventilator-associated events, as this has not been systematically studied. Further research on the usefulness of α-amylase as an aspiration biomarker and the role of oral suctioning, especially for certain populations, is indicated. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02284178.
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Affiliation(s)
- Mary Lou Sole
- University of Central Florida College of Nursing, Orlando, Florida
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Steven Talbert
- University of Central Florida College of Nursing, Orlando, Florida
| | - Xin Yan
- Department of Statistics, University of Central Florida College of Sciences, Orlando, Florida
| | - Daleen Penoyer
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Devendra Mehta
- Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, Florida
| | - Melody Bennett
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | | | - Aurea Middleton
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Lara Deaton
- Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, Florida
| | - Bassam Abomoelak
- Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, Florida
| | - Chirajyoti Deb
- Pediatric Specialty Diagnostic Laboratory, Arnold Palmer Hospital, Orlando Health, Orlando, Florida
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Ory J, Mourgues C, Raybaud E, Chabanne R, Jourdy JC, Belard F, Guérin R, Cosserant B, Faure JS, Calvet L, Pereira B, Guelon D, Traore O, Gerbaud L. Cost assessment of a new oral care program in the intensive care unit to prevent ventilator-associated pneumonia. Clin Oral Investig 2017; 22:1945-1951. [PMID: 29189950 DOI: 10.1007/s00784-017-2289-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP. MATERIALS AND METHODS In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…). RESULTS A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program. CONCLUSION AND CLINICAL RELEVANCE Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable. TRIAL REGISTRATION NCT02400294.
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Affiliation(s)
- Jérôme Ory
- Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France.
| | - Charline Mourgues
- Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Evelyne Raybaud
- Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France
| | - Russell Chabanne
- Réanimation Neurochirurgicale, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Réanimation Médico-Chirurgicale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | | | - Fabien Belard
- Département de l'Information Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Renaud Guérin
- Réanimation Médico-Chirurgicale Estaing, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bernard Cosserant
- Réanimation Cardio Vasculaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Laure Calvet
- Réanimation Médicale, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Dominique Guelon
- Réanimation Médico-Chirurgicale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Ousmane Traore
- Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France
| | - Laurent Gerbaud
- Santé Publique, CHU Clermont-Ferrand, Clermont-Ferrand, France
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