De-Implementation of Chlorhexidine Oral Care in the Intensive Care Unit: A Clinical Nurse Specialist Led...

In 2022, updated strategies to reduce ventilator-associated pneumonia (VAP) were published that no longer recommend the routine use of chlorhexidine oral care in mechanically ventilated adult patients. The lack of evidence to support positive impact on patient outcomes prompted Clinical Nurse Specialists to lead a de-implementation initiative to align standard practice with the latest evidence-based literature.

The CNSs led a multidisciplinary team including pharmacy, infection prevention, supply chain, physicians, and nursing informatics to revise VAP protocols, update critical care order sets, and implement a new oral care kit without chlorhexidine. The initiative was guided by the PDSA framework and de-implementation strategies. Outcome metrics were collected over the next 15 months to include infection rates and financial impact.

Ventilator adverse events (VAE) decreased by 27.8%, with infection rates steadily declining by 6.45% per quarter. The standard infection rate also decreased by 19.7% after de-implementation. Financial spending and usage data over the last 15 months indicated a direct cost avoidance of $125,000 if? chlorhexidine oral care kits continued to be used.

The de-implementation successfully eliminated a low-value, non-evidence-based nursing task, while reducing infection rates and generating cost savings for the organization. This highlights the pivotal role of the CNS in evaluating nursing practices to ensure they are grounded in current evidence rather than historic precedent.