Semester

Summer

Date of Graduation

2026

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Becky Smeltzer

Committee Member

Mike Frame

Committee Member

Cara Hawkins

Committee Member

Dana Scudiere

Committee Member

Nicole Scherrer

Committee Member

Gina Carenbauer

Committee Member

Mike Frame

Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a concerning complication that can

develop from complications when a patient is placed on a mechanical ventilator. Endotracheal

intubation puts patients at risk for micro aspiration, which can lead to VAP.

Evidence Review: Nine articles were selected for review; after critical appraisal, seven were

kept for further review. Evidence in these articles shows that using evidence-based methods in a

VAP bundle can decrease the length of stay, mechanical ventilator days, and the incidence of

VAP.

Purpose: The purpose of this project was to improve oral care for intubated patients and keep

the incidence of VAP to zero percent. Additionally, this project aimed to reduce the use of oral

chlorhexidine as it has been clinically disproven to benefit patient outcomes.

Methods: This quality improvement project was implemented to show that a VAP bundle

effectively reduces VAP incidence. Implementation was conducted through education of staff in

the Medical Intensive Care Unit at Ruby Memorial Hospital of the use of a VAP bundle.

Evaluation was conducted by comparing VAP data before and after the project implementation.

Results: Oral chlorhexidine use decreased; however, incorrect documentation of oral

chlorhexidine was observed with nursing. VAP rates remained at zero during implementation

Conclusion: The project demonstrated that using oral care kits instead of oral chlorhexidine did

not increase VAP, length of stay, mechanical ventilation days, or days spent in the hospital.

Findings highlight that continued education is needed to correctly document oral care and

sustained support from leadership to continue the quality improvement.

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