Updated June 02, 2014.

Background

According to the Centers for Disease Control (CDC), Ventilator Associated Pneumonia (VAP) is one of the most common healthcare-acquired infections (HAIs). It develops when a patient who uses a ventilator to breath develops a lung infection. The oxygen circulates from the ventilator through a tube that is inserted into the patient's mouth or nose, or through a hole in the front of the patient's neck.

If bacteria colonizes in this area, they can aspire into the lungs, and thus plant the site of infection. VAP has become the most common type of HAI for Intensive Care Unit (ICU) patients. Various studies have reported mortality rates of 46%, and as high as 76%.
VAP extends the hospital stay on average of 5 to 11 days, and thus increases the cost of care by tens of thousands of dollars. And since it is acquired during the hospital stay, the reimbursement rate from Medicare and even more and more private insurers, has diminished. Hospitals must cover these additional costs from their own pocket. Without a doubt, hospitals have become highly motivated to prevent VAP.

The Institute for Healthcare Improvement (IHI) and VAP

The IHI suggests that healthcare facilities implement what they have termed, "The Ventilator Bundle." The Ventilator Bundle is a series of best practices that, when implemented together, will help clinical staff to reduce and prevent VAP in patients while under their care.

The Ventilator Bundle

1. Elevation of the head of the bed (30-45 degrees)

1. Daily "Sedation Vacations" and Assessment of Readiness to Extubate (remove the tube from the patient)
2. Peptic Ulcer Disease Prophylaxis
3. Deep Venous Thrombosis Prophylaxis
4. Daily Oral Care with Chlorhexidine (CHG)

How Do Medical Manufacturers Help?

Manufacturers like Medline, Sage, and Kimberly Clark have created protocol kits to help staff easily follow the IHI's Ventilator Bundle, the daily oral care step, in particular.

What to Look For When Evaluating VAP Prevention Kits

1. Does the kit provide an education program?
   • Online training with a competency validation for staff
   • Tracking system for staff training compliance
   • Point of Care Training
   • Patient and Family education tool
   • Kit packaging the educates, instructs, and walks the nurse through the steps in a very clear manner, emphasizing not only how to clean the patient's mouth, but also with which oral care wash, and at what time interval
   • A clearly documented VAP oral care protocol template included with the kit
   • Some manufacturers even offer a VAP program manager to help staff track their success with incidence and financial reporting
2. Does the kit provide oral care choices?
   • Q2 and Q4 frequency kits
   • CHG oral rinse
   • Biotene mouthwash for alcohol-free moisturizing
   • Hydrogen Peroxide mouthwash for proven antisepsis
3. Is the kit easy to use at the bedside? Does it reinforce staff training and competency?
   • The pack may be color-coded
   • The pack may be packed to dispense each single-use kit in a sequential manner
   • The pack may allow staff to confirm their protocol compliance with a quick look at the kit packaging
4. Does the kit itself educate nurses how to use it?
   • Are the IHI Ventilator Bundle guidelines on the package for clinician reference?
   • Are the q-protocol and kit types color-coded to help avoid mistakes?
   • Does the kit provide space on it for staff to label the patient's name, date, time, to further prevent mistakes or infection?
   • Is the kit set up to reduce human error by using a sequential dispensing method?
   • Are there additional tips on the kit to help staff assess the patient's oral health?
   • Is the kit physically convenient to store in a visible place for the staff to monitor (and remember) to use?

Kit Contents: What to look for

• Oral Care Set-Up
  • Typically would include an oral care suction tip such as a yankauer
  • A wide-angle "Y" connector
  • A turn-valve for the yankauer suction tip
• Suction toothbrush and catheter
  • These are the individually dispensed kits that would include the CHG, peroxide, or Biotene
  • A catheter for subglottal suction
  • A soft bristle toothbrush, and a cleaning implement like a pad for care of the gums and tongue
  • Moisturizing gel and a swab to apply it
• Suction Swab Kit
  • Dry mouth mouthwash (such as Biotene)
  • Hydrogen Peroxide mouthwash
  • Swab
  • moisturizing gel for dry mouth moisture restoration