1. The Importance of Clinical Oral Care

2. Hospital-Acquired Pneumonia (HAP)
Oral cavity plays key role
in HAP development
Includes ventilator-
associated pneumonia (VAP)
Scannapieco FA, et al., J Periodontology. 1999; 70(7);

3. Hospital-Acquired Pneumonia (HAP)
Defined as: Pneumonia that occurs 48 hours or more after admission, that was not incubating at the time of admission.
American Thoracic Society
Am J. Respir Crit Care Med Vol 171, pp , 2005

4. Hospital-Acquired Pneumonia (HAP)
Rate of between 5 and 10 cases per 1,000 hospital admissions
Incidence of HAP increases by 6-20 fold in vented patients
Accounts for up to 25% of all ICU infections
Nearly 90% of ICU HAP episodes occur during mechanical ventilation
Am J. Respir Crit Care Med Vol 171, pp , 2005

5. Ventilator-Associated Pneumonia (VAP)
Defined as: Pneumonia that arises more than hours after endotracheal intubation.
American Thoracic Society
Am J. Respir Crit Care Med Vol 171, pp , 2005

6. Ventilator-Associated Pneumonia (VAP)
VAP has a high mortality rate and extends length of stay1
Mean hospital costs range between $40,0002 and $150,00 per episode3
Approximately half of all VAP episodes occur during the first 4 days of hospitalization1
Garcia, R., Jendresky, L., & Colbert, L. (unpublished work 2004). Reduction of microbial colonization in the oropharynx and dental plaque reduces ventilator-associated pneumonia.
Kunis, K. & Puntillo, K.A. (2003). Ventilator-associated pneumonia in the ICU: its pathophysiology, risk factors, and prevention. American Journal of Nursing, 103(8), 64AA-64GG.
National Nosocomial Infections surveillance (NNIS) System Report, data summary from (2004). CDC NNIS, October 2004.
Richards, M.J., Edwards, J.R., Culver, D.H., & Gaynes, R.P. (1999). Nosocomial infections in medical intensive care units in the United States. Critical Care Medicine, 27(5),
Schleder, B.J. (2003). Taking charge of ventilator-associated pneumonia. Nursing Management, 34(8),
Schleder, B.J., Stott, K., & Lloyd, R.C. (2002). The Effect of a comprehensive oral care protocol on patients at risk for ventilator-associated pneumonia. Journal of advocate Health Care, 4(1),
Simmons-Trau, D., Cenek, P., Counterman, J., Hockenbury, D., & Litwiller, L. (2004). Reducing VAP with 6 Sigma. Nursing Management, 35(6),
Am J. Respir Crit Care Med Vol 171, pp , 2005
Kollef MH, et al., Chest. Dec 2005;128(6) ):

7. High Mortality Hospital-associated pneumonias
Fatal for 20 to 33% of patients
Source: Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, CDC/HICPACL 8-9.

8. High Mortality, Longer Stays, Increased Costs
Length of Stay
Mean Hospital Charges
HAP
18.8%
15.2 days
$65,292
VAP
29.3%
23 days
$150,841
Kollef MH, et al., Chest. Dec 2005;128(6):

9. VAP=Longer Stays 9.6 more days on the Vent 6.1 more days in the ICU
11.5 more days in the Hospital
Rello J. et al., Chest. Dec 2002; 122(6):

10. VAP=Increased Costs > $40,000 per case to treat
Facility pays the bill
Rello J. et al., Chest. Dec 2002; 122(6):

11. $105M ORAL CARE: SUCTION and NON-SUCTION Sage Kimberly-Clark/Ballard
Annual 2011 Market
Kimberly-Clark/Ballard
Trademark Medical
Tri-State Medical
Medline
Others*
89.2%
6.6%
3.9%
0.3%
0.1%
<0.1% each
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data
* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries,

12. $86.7M ORAL CARE: SUCTION Sage Kimberly-Clark/Ballard
Annual 2011 Market
Kimberly-Clark/Ballard
Trademark Medical
Medline
89.6%
6.7%
3.5%
.2%
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data

13. $18.9M ORAL CARE: NON-SUCTION Sage Kimberly-Clark/Ballard Medline
Annual 2011 Market
Kimberly-Clark/Ballard
Medline
Others*
84.5%
5.9%
5.5%
<1.1% each
Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data
* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries, Tri-State, PDI

14. Market Review – VAP Prevention
Q-Care Petite
~ 73.7 K Days 1%
Q-Care Units ~ 2.1 M Days 28.5%
Vent Days* (Adult and Pediatric) ~7.4 M Days Available Market: 70.5%
*Source: Principal Procedure outcomes for respiratory intubation and ventilation: Healthcare Cost and Utilization Project (HCUP), 2006, Q-Care Sales figures: Sage Sales from September 2007 – August 2008

15. The Effect of a Comprehensive Oral Care Protocol on Patients at Risk for Ventilator- Associated Pneumonia
Implemented a comprehensive oral care program
Reduced VAP
by 60%
Schleder B. et al., J Advocate Health Care. 2002

16. CDC Guidelines References Schleder’s work... “...Develop and implement
a comprehensive
oral-hygiene program…”.
Source: Guidelines for Preventing Health-Care-Associated Pneumonia, 2003, CDC/HICPAC:8-9.

17. AACN News Robert Garcia BS, MMT(ASCP),CIC
Implemented a comprehensive oral care program
Reduced VAP’s by 42.1%
Avoided cost $722,975
Statistically Significant
Vollman K, Garcia R, AACN News, August 2005, Volume 22, No. 8.

18. Three of the VAP Risk Factors
1) Bacterial colonization of the oropharyngeal area
2) Aspiration of subglottic secretions (routine suctioning minimizes oral secretions that can migrate to the subglottic area.)
3) Colonization of dental plaque with respiratory pathogens
Schleder B. et al., J Advocate Health Care. 2002

19. Evidence-Based Protocol
Assessment
Cleaning
Debriding
Suctioning
Moisturizing

20. AACN Procedure Manual for Critical Care
“In addition to brushing twice daily, use oral swabs with 1.5% hydrogen peroxide solution to clean mouth every 2 to 4 hours. With each cleansing, apply a mouth moisturizer to the oral mucosa and lips to keep tissue moist”
Q12 Brushing
Q2-Q4 Swabbing
Moisturize after each cleaning

21. Customize Your Protocol

22. Protocol Support Tool

23. Performance Improvement Plan

24. Celebrate Your Success!

25. Thank You For Your Time