P41 – Teaching Providers Pre-Intubation Oral Cleansing Using Video-based Training

Author(s):
Courtney Sommer, Gareth Gilna, Peter Louras, Miriam Treggiari, David Carlbom, Eileen Bulger, Heather Evans, Harborview Medical Center

Background: Emergently intubated patients are at significant risk of developing ventilator-associated pneumonia (VAP). Pre-intubation chlorhexidine gluconate (CHX) mouth cleansing is effective in preventing pneumonia in electively intubated surgical patients, but it is unknown whether this procedure can be safely and effectively performed in a prehospital setting.

Hypothesis: We hypothesize that an instructional video can be used to teach pre-intubation oral cleansing to providers with different airway training backgrounds.

Methods: We created a brief instructional video to demonstrate preparation of a 0.05% CHX swab and appropriate oral swabbing technique and duration. We then evaluated the teaching effectiveness of this video-based training in 10 care providers who were asked to view the video. Participants were observed demonstrating the oral cleansing procedure in volunteer subjects undergoing intubation prior to elective surgery. Performance was measured by an observer and self-reported according to the following parameters: 1) use of the entire 5 mL of solution, 2) adequate oropharyngeal coverage of 6 pre-defined areas, and 3) duration of cleansing between 10-15 seconds.

Results: Nine of 10 (90%) participants covered all 6 required oropharyngeal areas. One paramedic student failed to swab under the tongue. Four paramedic students and 1 respiratory therapist self-reported that they failed to use the entire 5 mL of fluid, but the study observer only confirmed this in one subject. All of the participants completed the task in less than 15 seconds. The subjects uniformly reported that they felt adequately prepared by the training for both the current study setting and the proposed prehospital setting. There were no adverse events and there were no observed or perceived delays in intubation as a result of the study procedure. Participants remarked that the procedure would be significantly easier by improved packaging of the swab.

Conclusions: Our study participants effectively performed pre-intubation oral cleansing after watching a brief instructional video without delaying intubation. This suggests that wider-scale implementation of this video-based teaching method is feasible for future studies investigating the effect of pre-intubation mouth cleansing on VAP rates. This approach is particularly relevant and efficient for training providers in a multicenter trial setting where procedure standardization and scalability are essential.