Improving Oral Care to Reduce Hospital-Acquired Pneumonia (HAP) in the Acute Neurologically Impaired Adult
NCT ID: NCT01498601
Last Updated: 2015-09-22
Study Results
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View full resultsBasic Information
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COMPLETED
NA
32 participants
INTERVENTIONAL
2012-01-31
2012-10-31
Brief Summary
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Detailed Description
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Gap: Research studies have shown improving oral hygiene in critical care, neuroscience intensive care units and cardiac surgery reduces the incidence of HAP. However, in the acutely ill neuroscience population outside critical care areas, this relationship has not been determined. Current oral care protocols, products and practitioner practice on medical/surgical units such as the RCH neuroscience unit do not consider recent evidence or recent increases in patient acuity and complexity.
Goal: The goal of this study is to test the efficacy of an improved, evidence-based oral care protocol in reducing HAP in this population on the medical/surgical neuroscience unit at RCH.
Research question: Does implementing an enhanced oral care protocol reduce rates of HAP in the acute, non-intubated, care-dependent, neurologically impaired, adult patient on a neuroscience unit?
Objective: To measure and compare the incidence of HAP among medical/surgical patients who had the current standard of oral care with those receiving an improved, preventative-based, oral hygiene protocol including regular teeth brushing, mouth and tongue inspection, swabbing and moisturizing, elevation of head of the bed (HOB), changing of suction equipment, and universal precautions.
Relevance: This study may identify the importance of standardizing oral hygiene protocols to the evidence, and heighten awareness among care providers in the prevention of HAP. If proven successful, the oral care protocol could be considered for implementation on acute units outside the RCH neuro unit.
Conditions
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Study Design
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NON_RANDOMIZED
SINGLE_GROUP
TREATMENT
NONE
Study Groups
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Oral care treatment group
All subjects in the prospective intervention group will receive the same enhanced oral care protocol
Enhanced oral care protocol
* Changing mouth suction equipment every 24 hours
* Mouth assessment every 2-4 hours
* Cleansing mouth with toothbrush every 12 hours
* Cleansing oral mucosa with oral rinse solution every 2-4 hours
* Moisturize mouth/lips with swab and standard mouth moisturizer every 4 hours
* Suction mouth and throat as needed
* Head of the bed elevated to a minimum of 30° during oral care
Retrospective study group
For comparison purposes, a retrospective chart review of matched in-patient population will reveal pneumonia rates in the same population who did not receive the enhanced oral care protocol.
No interventions assigned to this group
Interventions
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Enhanced oral care protocol
* Changing mouth suction equipment every 24 hours
* Mouth assessment every 2-4 hours
* Cleansing mouth with toothbrush every 12 hours
* Cleansing oral mucosa with oral rinse solution every 2-4 hours
* Moisturize mouth/lips with swab and standard mouth moisturizer every 4 hours
* Suction mouth and throat as needed
* Head of the bed elevated to a minimum of 30° during oral care
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Admitted to RCH neuroscience unit
* Primary diagnosis is neurological (brain injury/insult)
* Non-intubated
* Dependent for oral care and unable to direct their own oral care
Exclusion Criteria
* Off service patients
* Intubated, on bilevel positive airway pressure or continuous positive airway pressure devices, (respiratory assistive devices)
* Palliative
* Capable of directing their own oral care
* Unable to receive oral care due to: oral tubes, nasal/oral airways, wired jaws, or behaviours such as resistiveness, combativeness, non-compliance, etc.
19 Years
ALL
No
Sponsors
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Fraser Health
OTHER
Responsible Party
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Principal Investigators
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Trudy L. Robertson, MSN
Role: PRINCIPAL_INVESTIGATOR
Fraser Health Authority
Dulcie J. Carter, MMedSci
Role: PRINCIPAL_INVESTIGATOR
Fraser Health Authority
Locations
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Royal Columbian Hospital
New Westminster, British Columbia, Canada
Countries
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References
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Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001 Mar 1;344(9):665-71. doi: 10.1056/NEJM200103013440908. No abstract available.
Marik PE, Kaplan D. Aspiration pneumonia and dysphagia in the elderly. Chest. 2003 Jul;124(1):328-36. doi: 10.1378/chest.124.1.328.
Munro CL, Grap MJ. Oral health and care in the intensive care unit: state of the science. Am J Crit Care. 2004 Jan;13(1):25-33; discussion 34.
Perry & Potter. Fraser Health Nursing Skills for Mouth Care for the Unconscious or Debilitated Patient. Mosby's Nursing Skills: Clinical Nursing Skills & Techniques (7th Ed.). St. Louis. Retrieved April 14th, 2011 from: http://app44.webinservice.com/NursingSkills/ContentPlayer/SkillContentPlayerIFrame.aspx?KeyId=598&Id=GN_14_3&Section=1&bcp=Index~M~False&IsConnect=False
Shigemitsu H, Afshar K. Aspiration pneumonias: under-diagnosed and under-treated. Curr Opin Pulm Med. 2007 May;13(3):192-8. doi: 10.1097/MCP.0b013e3280f629f0.
Terpenning MS, Taylor GW, Lopatin DE, Kerr CK, Dominguez BL, Loesche WJ. Aspiration pneumonia: dental and oral risk factors in an older veteran population. J Am Geriatr Soc. 2001 May;49(5):557-63. doi: 10.1046/j.1532-5415.2001.49113.x.
American Association of Critical Care Nurses. AACN Practice Alert: Oral Care for Patients at Risk for Ventilator-Associated Pneumonia. Retrieved April 10, 2011 from: http://www.aacn.org
Bopp M, Darby M, Loftin KC, Broscious S. Effects of daily oral care with 0.12% chlorhexidine gluconate and a standard oral care protocol on the development of nosocomial pneumonia in intubated patients: a pilot study. J Dent Hyg. 2006 Summer;80(3):9. Epub 2006 Jul 1.
Chan EY, Ruest A, Meade MO, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ. 2007 Apr 28;334(7599):889. doi: 10.1136/bmj.39136.528160.BE. Epub 2007 Mar 26.
Cohn JL, Fulton JS. Nursing staff perspectives on oral care for neuroscience patients. J Neurosci Nurs. 2006 Feb;38(1):22-30. doi: 10.1097/01376517-200602000-00006.
DeRiso AJ 2nd, Ladowski JS, Dillon TA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996 Jun;109(6):1556-61. doi: 10.1378/chest.109.6.1556.
Fields LB. Oral care intervention to reduce incidence of ventilator-associated pneumonia in the neurologic intensive care unit. J Neurosci Nurs. 2008 Oct;40(5):291-8. doi: 10.1097/01376517-200810000-00007.
Grap MJ, Munro CL, Ashtiani B, Bryant S. Oral care interventions in critical care: frequency and documentation. Am J Crit Care. 2003 Mar;12(2):113-8; discussion 119.
Hilker R, Poetter C, Findeisen N, Sobesky J, Jacobs A, Neveling M, Heiss WD. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke. 2003 Apr;34(4):975-81. doi: 10.1161/01.STR.0000063373.70993.CD. Epub 2003 Mar 13.
Houston S, Hougland P, Anderson JJ, LaRocco M, Kennedy V, Gentry LO. Effectiveness of 0.12% chlorhexidine gluconate oral rinse in reducing prevalence of nosocomial pneumonia in patients undergoing heart surgery. Am J Crit Care. 2002 Nov;11(6):567-70.
Langmore SE, Terpenning MS, Schork A, Chen Y, Murray JT, Lopatin D, Loesche WJ. Predictors of aspiration pneumonia: how important is dysphagia? Dysphagia. 1998 Spring;13(2):69-81. doi: 10.1007/PL00009559.
Prendergast V, Hallberg IR, Jahnke H, Kleiman C, Hagell P. Oral health, ventilator-associated pneumonia, and intracranial pressure in intubated patients in a neuroscience intensive care unit. Am J Crit Care. 2009 Jul;18(4):368-76. doi: 10.4037/ajcc2009621.
Reimer-Kent J. From theory to practice: preventing pain after cardiac surgery. Am J Crit Care. 2003 Mar;12(2):136-43.
Rotstein C, Evans G, Born A, Grossman R, Light RB, Magder S, McTaggart B, Weiss K, Zhanel GG. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults. Can J Infect Dis Med Microbiol. 2008 Jan;19(1):19-53. doi: 10.1155/2008/593289.
Safdar N, Crnich CJ, Maki DG. The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care. 2005 Jun;50(6):725-39; discussion 739-41.
Shorr AF, Kollef MH. Ventilator-associated pneumonia: insights from recent clinical trials. Chest. 2005 Nov;128(5 Suppl 2):583S-591S. doi: 10.1378/chest.128.5_suppl_2.583S.
Thompson DA, Makary MA, Dorman T, Pronovost PJ. Clinical and economic outcomes of hospital acquired pneumonia in intra-abdominal surgery patients. Ann Surg. 2006 Apr;243(4):547-52. doi: 10.1097/01.sla.0000207097.38963.3b.
Yoon, M. & Steele, C. The oral care imperative: The link between oral hygiene and aspiration pneumonia. Topics in Geriatric Rehabilitation. 23(3), 280-288.
Shi Z, Xie H, Wang P, Zhang Q, Wu Y, Chen E, Ng L, Worthington HV, Needleman I, Furness S. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2013 Aug 13;(8):CD008367. doi: 10.1002/14651858.CD008367.pub2.
Other Identifiers
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FDAAA
Identifier Type: -
Identifier Source: org_study_id
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