ISR 64 - Impact of Implementing Oral Care in Non-ventilated Patients in an Intensive Care Unit on Hospital-onset Bacteremia Secondary to Pneumonia

Background: Patients receiving care in the intensive care unit (ICU) have increased risk for developing healthcare-acquired bacteremia infections secondary to pneumonia. Oral hygiene is a key strategy in reducing the risk for hospital-acquired pneumonia. This study assesses the impact routine oral care in non-ventilated (NV) patients in an ICU has on hospital-onset (HO) bacteremia secondary to pneumonia.

Methods: A multidisciplinary team developed a pre-post intervention study with two oral care interventions implemented consecutively, targeting NV-patients in the ICU. The first intervention offered oral care every two hours to patients with risk factors for aspiration or inability to perform oral care independently. The second offered oral care every four hours during daytime hours to all NV-patients. In both interventions staff received education on the importance of proper oral hygiene in hospitalized patients. The rate of HO-bacteremia infections secondary to pneumonia and the proportion of all HO-bacteremia infections were measured at a baseline period, after each intervention period, and at the one year mark. Rates were compared to the baseline period using rate ratios.

Results: The rate of HO-bacteremia secondary to pneumonia after each intervention was compared to an established baseline rate of 2.26 per 1000 patient days. The rate decreased to 1.54 after the first (p=0.43), 1.83 (p=0.71) after the second, and 0.88 (p=0.20) at the one year mark. Baseline proportion of all HO-bacteremia in the ICU was 54%. The proportion of all HO-bacteremia remained stable at 52%, 40%, and 50% after the first intervention, second intervention, and at one year respectively.

Conclusions: This study found no statistically significant reduction in HO-bacteremia infections secondary to pneumonia. However, a sustained rate reduction with a stable proportion of all HO-bacteremia infections, demonstrates the benefit of using routine oral care as a strategy to reduce HO-bacteremia infections secondary to pneumonia in NV-patients in the ICU.