As healthcare reimbursement moves away from fee-for-service arrangements and toward value-based payments, providers are looking for ways to reduce rates of healthcare-associated infections, which are detrimental to patients and drive up costs. Ventilator-associated pneumonia (VAP) is a healthcare-associated infection that may develop in up to 15% of mechanically ventilated patients. Efforts to prevent VAP have focused on the use of what are known as care bundles--a series of interventions that are recommended for consistent, simultaneous implementation. One component of the VAP bundle is regular oral care.
Oral decontamination with antiseptic rinses such as oral chlorhexidine (CHG) and mechanical brushing is intended to decrease the bacterial colonization on dental plaque biofilm and throughout the oral cavity. This reduction of the microbial burden in the upper respiratory tract may potentially reduce VAP rates. CHG antiseptic rinse (0.12%) has been FDA approved for use as an antiseptic rinse since 1986 with broad spectrum oral antimicrobial efficacy. Other agents that have been studied for VAP oral care include herbal solutions, povidone-saline solutions, and essential oils. Recently, Biotene products have been studied in mechanically ventilated neonates.
One of our clients recently asked us to review the evidence comparing Biotene with oral CHG in both adult and pediatric populations for prevention of VAP. In our search of PubMed, FDA databases, and the Internet we found a lack of evidence directly comparing oral Biotene to oral CHG as a preventive strategy for VAP.
These guidelines provide more information on strategies to implement to prevent VAP and other healthcare-associated infections:
- Society for Healthcare Epidemiology of America and the Infectious Disease Society of America Practice Recommendation. Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals: 2014 update.
- Health and Human Services. National Action Plan to Prevent Healthcare-Associated Infections: Road Map to Elimination (2013).
- Institute for Healthcare Improvement. How-to Guide: Prevent Ventilator-Associated Pneumonia (2012).
- Institute for Clinical Systems Improvement ICSI. Healthcare Protocol: Prevention of VAP (2011).