Reducing ventilator-associated pneumonia through advanced oral-dental care: a 48-month study

Am J Crit Care. 2009 Nov;18(6):523-32. doi: 10.4037/ajcc2009311. Epub 2009 Jul 27.


Objective: To determine the effect of implementing a comprehensive oral and dental care system and protocol on the rate of ventilator-associated pneumonia.

Methods: Patients more than 18 years old receiving mechanical ventilation for more than 48 hours in a medical intensive care unit at a university-affiliated medical center were studied in 2 consecutive 24-month periods. Patients in the group studied before the intervention (n = 779) had no oral assessments, no suctioning of the subglottic space, no toothbrushing, and suctioning of secretions in the oral cavity as needed. The group studied during the intervention (n = 759) included patients treated under a protocol whereby the oral cavity was assessed, deep suctioning was done every 6 hours, oral tissue cleansing was done every 4 hours or as needed, and toothbrushing was done twice daily.

Results: Compliance with protocol components exceeded 80%. The groups did not differ significantly in age, sex, or severity of illness. The rate of ventilator-associated pneumonia was 12.0 per 1000 ventilator days before the intervention and decreased to 8.0 per 1000 ventilator days during the intervention (P = .06). Duration of mechanical ventilation and length of stay in the intensive care unit differed significantly between groups, as did mortality.

Conclusion: Our findings suggest that use of advanced tools, a comprehensive oral care protocol, and staff compliance with the protocol can significantly reduce rates of ventilator-associated pneumonia and associated costs.

Publication types

  • Clinical Trial

MeSH terms

  • Academic Medical Centers
  • Aged
  • Dental Plaque / microbiology
  • Female
  • Guideline Adherence*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Intensive Care Units / organization & administration
  • Length of Stay
  • Male
  • Middle Aged
  • Oral Hygiene / methods*
  • Oropharynx / microbiology
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Practice Guidelines as Topic*
  • Process Assessment, Health Care
  • Stomach / microbiology