Hygiène Hospitalière, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 Rue Montalembert, Clermont-Ferrand, Auvergne Rhône-Alpes, France.
Direction Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France.
Clin Oral Investig. 2018 Jun;22(5):1945-1951. doi: 10.1007/s00784-017-2289-6. Epub 2017 Nov 30.
Ventilator-associated pneumonia (VAP) is the most frequent hospital-acquired infections in intensive care units (ICU). In the bundle of care to prevent the VAP, the oral care is very important strategies, to decrease the oropharyngeal bacterial colonization and presence of causative bacteria of VAP. In view of the paucity of medical economics studies, our objective was to determine the cost of implementing this oral care program for preventing VAP.
In five ICUs, during period 1, caregivers used a foam stick for oral care and, during period 2, a stick and tooth brushing with aspiration. Budgetary effect of the new program from the hospital's point of view was analyzed for both periods. The costs avoided were calculated from the incidence density of VAP (cases per 1000 days of intubation). The cost study included device cost, benefit lost, and ICU cost (medication, employer and employee contributions, blood sample analysis…).
A total of 2030 intubated patients admitted to the ICUs benefited from oral care. The cost of implementing the study protocol was estimated to be €11,500 per year. VAP rates decreased significantly between the two periods (p1 = 12.8% and p2 = 8.5%, p = 0.002). The VAP revenue was ranged from €28,000 to €45,000 and the average cost from €39,906 to €42,332. The total cost assessment calculated was thus around €1.9 million in favor of the new oral care program.
Our study showed that the implementation of a simple strategy improved the quality of patient care is economically viable.
NCT02400294.
呼吸机相关性肺炎（VAP）是重症监护病房（ICU）中最常见的医院获得性感染。在预防 VAP 的护理措施中，口腔护理是非常重要的策略，可以减少口咽部细菌定植和 VAP 病原菌的存在。鉴于缺乏医学经济学研究，我们的目的是确定实施该口腔护理方案预防 VAP 的成本。
在五个 ICU 中，在第 1 阶段，护理人员使用泡沫棒进行口腔护理，在第 2 阶段，使用棒和牙刷进行吸引式口腔护理。从医院角度分析了新方案在两个阶段的预算效果。从 VAP 的发病率密度（每千天插管例数）计算避免的成本。成本研究包括设备成本、收益损失和 ICU 成本（药物、雇主和员工缴费、血液样本分析等）。
共有 2030 名接受 ICU 插管的患者受益于口腔护理。实施研究方案的成本估计为每年 11500 欧元。两个阶段 VAP 发生率显著下降（p1=12.8%和 p2=8.5%，p=0.002）。VAP 收入范围为 28000 至 45000 欧元，平均成本为 39906 至 42332 欧元。因此，总评估成本有利于新的口腔护理方案，约为 190 万欧元。
我们的研究表明，实施简单策略提高了患者护理质量，在经济上是可行的。
NCT02400294。
