The Importance of Clinical Oral Care

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); 793-802.

• Defined as: Pneumonia that occurs 48 hours or more after admission, that was not incubating at the time of admission.

– American Thoracic Society

Hospital-Acquired Pneumonia (HAP)

Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005

• 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. 388-416, 2005

Hospital-Acquired Pneumonia (HAP)

• Defined as: Pneumonia that arises more than 48-72 hours after endotracheal intubation.

– American Thoracic Society

Am J. Respir Crit Care Med Vol 171, pp. 388-416, 2005

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

1. Am J. Respir Crit Care Med Vol 171, pp. 388-416, 20052. Kollef MH, et al., Chest. Dec 2005;128(6) ):3854-62

Ventilator-Associated Pneumonia (VAP)

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.

High Mortality, Longer Stays, Increased Costs

Mortality

Length of Stay

Mean HospitalCharges

VAP

29.3%

23 days

$150,841

HAP

18.8%

15.2 days

$65,292

Kollef MH, et al., Chest. Dec 2005;128(6):3854-62.

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): 2115-21

VAP=Increased Costs

• > $40,000 per case to treat

• Facility pays the bill

Rello J. et al., Chest. Dec 2002; 122(6): 2115-21

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries,

ORAL CARE: SUCTION and ORAL CARE: SUCTION and NON-SUCTIONNON-SUCTION

ORAL CARE: SUCTION and ORAL CARE: SUCTION and NON-SUCTIONNON-SUCTION

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89.2%89.2%89.2%89.2% 6.6%6.6%6.6%6.6% 3.9%3.9%3.9%3.9% 0.3%0.3%0.3%0.3% 0.1%0.1%0.1%0.1% <0.1% <0.1% eacheach<0.1% <0.1% eacheach

Annual 2011 MarketAnnual 2011 Market

Tri-Sta

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Medica

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State

Medica

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Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

ORAL CARE: SUCTIONORAL CARE: SUCTIONORAL CARE: SUCTIONORAL CARE: SUCTION

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SageSage

89.6%89.6%89.6%89.6% 6.7%6.7%6.7%6.7% 3.5%3.5%3.5%3.5% .2%.2%.2%.2%

Annual 2011 MarketAnnual 2011 Market

Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

* others include: Dynarex, Cardinal Health Hosp Supply, Medical Action Industries, Tri-State, PDI

ORAL CARE: NON-SUCTIONORAL CARE: NON-SUCTIONORAL CARE: NON-SUCTIONORAL CARE: NON-SUCTION

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Others

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84.5%84.5%84.5%84.5% 5.9%5.9%5.9%5.9% 5.5%5.5%5.5%5.5% <1.1% <1.1% eacheach<1.1% <1.1% eacheach

Annual 2011 MarketAnnual 2011 Market

Source: GHX Trend Report (Dollars) 2nd Quarter, 2011 Hospital; Annual market represents last 4 quarters of data

Market Review – VAP Prevention

Q-Care Units ~ 2.1 M Days

28.5%

Vent Days* (Adult and Pediatric)

~7.4 M Days Available Market:

70.5%

Q-Care Petite

~ 73.7 K Days

1%

*Source: Principal Procedure outcomes for respiratory intubation and ventilation: Healthcare Cost and Utilization Project (HCUP), 2006, http://hcupnet.ahrq.gov/; Q-Care Sales figures: Sage Sales from September 2007 – August 2008

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

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.

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.

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

Evidence-Based Protocol

• Assessment• Cleaning• Debriding• Suctioning• Moisturizing

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

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