Cost Assessment of a New Oral Care Program in the Intensive Care Unit to Prevent Ventilator-associated Pneumonia
Ventilator-associated pneumonia (VAP) is one of the most frequently hospital-acquired
infections associated with ICU stays. Hospital-acquired infections affect 1.7 million people
annually, the cost associated with these infections is substantial. The estimated cost of the
combination of the five most common hospital-acquired infections is 8.9 billion euros or almost
9.8 billion dollars. Of this cost, 31.6% is attributed to VAP. A recent before and after the clinical
trial was conducted to assess the cost-effectiveness of implementing a more thorough oral care
program the results published November 2017 in Clinical Oral Investigations. 1
According to the CDC, the best and most effective way to prevent VAP is to complete oral
hygiene. This study took place over a 13-month period that was divided into two stages. In the
first stage that spanned 6 months, July 1st through December 31 st , standard oral care was not
modified. The current standard oral care was to have foam swabs or gauze soaked in a diluted
solution of CHX swabbed through the oral cavity 3 times a day.
The following January, the staff that cared for ICU patients were trained with the new program.
This consisted of using non-sterile single-use tools; a suctioning toothbrush with a long neck and
soft bristles and a suctioning swab meant to be used for fragile gums and tissue. Care was
performed 3 times a day, twice brushing and application of the CHX solution three times a day.
The annual cost of the original oral care program, including swabs and CHX was 680 euros or
744.20 dollars. The cost of the newly implemented oral care program, including toothbrushes,
swabs, and CHX annually was estimated to be 11,500 euros or 12,587.28 dollars.
The average cost to the hospital per case of VAP during the study was estimated to be 41,000
euros or 44,875.94 dollars. The implementation of the revised oral care program prevented 11
VAP cases per 1,000. The estimated cost savings to the hospital by implementing the new oral
care program was 3.7 million euros or a little over 4 million dollars in one year.
The study concluded that it is indeed cost-effective to implement this new oral care protocol. Not
to mention the reduction in the number of patients that acquire VAP during their ICU stay.
Additionally, a more thorough oral care protocol will most likely increase patients’ comfort.
With one simple change, the quality of patient care can be improved, and it is an economically
viable solution.
Do you agree that better oral care can benefit the patient and the hospital? Many studies have
shown a link between oral pathogens and VAP, in your opinion, why do you believe medical
facilities have not addressed this problem? With this study showing an economic benefit as well
as benefit to patients, do you anticipate changes in oral care protocol in ICU’s?
1. Ory J, Mourgues C, Raybaud E, et al. Clin Oral Investig. 2018;22(5):1945–1951.
doi:10.1007/s00784-017-2289-6
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