Oral Care Layered Enhancement for Improved Oral Hygiene in Intensive Care Units

NCT ID: NCT07129733

Last Updated: 2025-08-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

4800 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-09-01

Study Completion Date

2026-11-30

Brief Summary

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The goal of the ORACLE study is to evaluate the impact of implementing a standardized oral hygiene bundle on outcomes in critically ill, mechanically ventilated patients. The primary objective is to determine whether this bundle can increase the number of ventilator-free days compared to the standard of care.

Detailed Description

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The use of invasive mechanical ventilation (IMV) as an organ support measure is common in intensive care units (ICUs), with its prevalence ranging from 36% to 89%. Lower respiratory tract infections (LRTIs) are known to be the primary site of infection related to sepsis in critically ill patients in Brazilian ICUs and are associated with high morbidity and mortality.

It is well established that the oral cavity is a source of pathogens leading to LRTIs in critically ill patients, with dental plaque serving as an important reservoir of these pathogens. Therefore, oral hygiene in critically ill patients is an essential measure for the prevention of LRTIs, as recommended by both international and national guidelines.

Simple cleaning of the oral cavity using a toothbrush or oral swab, in addition to providing comfort and well-being to the patient, contributes to the prevention of LRTIs and other infections. A recent meta-analysis evaluating the impact of standardized toothbrushing on clinical outcomes showed that this care intervention was associated with a lower incidence of LRTIs and reduced mortality. On the other hand, an international clinical trial demonstrated that the implementation of an oral care bundle combined with the de-implementation of chlorhexidine for oral care was not associated with improved outcomes.

Based on the rationale supporting the benefits of implementing a standardized oral care, findings from previous studies, the conflicting literature regarding the effectiveness of oral care protocols that include the de-implementation of chlorhexidine on clinical outcomes in ICU patients, and the scarcity of data from developing countries such as Brazil, conducting a clinical trial is needed.

Conditions

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Mechanical Ventilation Infection Prevention Oral Care Oral Hygiene, Oral Health VAP - Ventilator Associated Pneumonia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

This is a stepped wedge cluster randomized clinical trial, with a 11-month transition period between interventions.
Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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Oral hygiene bundle

This arm will receive the standardized oral hygiene bundle

Group Type EXPERIMENTAL

Oral hygiene bundle

Intervention Type OTHER

Implementation of the standardized oral hygiene bundle, which consists of the following key components: Standardization of materials used during the oral hygiene procedure, standardization of oral hygiene frequency, training of nursing staff involved in patient care on proper oral hygiene practices, discontinuation of routine application of chlorhexidine oral solution, and implementation of a standardized oral hygiene technique.

Standard of care

Each center will maintain its usual oral care practices.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Oral hygiene bundle

Implementation of the standardized oral hygiene bundle, which consists of the following key components: Standardization of materials used during the oral hygiene procedure, standardization of oral hygiene frequency, training of nursing staff involved in patient care on proper oral hygiene practices, discontinuation of routine application of chlorhexidine oral solution, and implementation of a standardized oral hygiene technique.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* All patients who receive mechanical ventilation in the participating intensive care units
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Faculdade de Medicina de Ribeirão Preto/USP

UNKNOWN

Sponsor Role collaborator

Hospital do Coracao

OTHER

Sponsor Role lead

Responsible Party

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Bruno Martins Tomazini

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Fernando Belissimo-Rodrigues, MD, PhD

Role: STUDY_CHAIR

Faculdade de Medicina de Ribeirão Preto da USP

Bruno M Tomazini, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital do Coração (Hcor)

Wanessa Belissimo-Rodrigues, PhD

Role: STUDY_CHAIR

Faculdade de Medicina de Ribeirão Preto da USP

Alexandre Biasi Cavalcanti, MD, PhD

Role: STUDY_DIRECTOR

Hospital do Coração (Hcor)

Locations

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Santa Casa de Misericordia de Passos

Passos, Minas Gerais, Brazil

Site Status

Hospital Municipal de Maringa

Maringá, Paraná, Brazil

Site Status

Hospital da Restauracao

Recife, Pernambuco, Brazil

Site Status

Hospital Santa Cruz

Santa Cruz, Rio Grande do Sul, Brazil

Site Status

Hospital Nereu Ramos

Florianópolis, Santa Catarina, Brazil

Site Status

Hospital Leo Orsi

Itapetininga, São Paulo, Brazil

Site Status

Countries

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Brazil

Central Contacts

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Bruno M Tomazini, MD

Role: CONTACT

+5511982839173

Wanessa Belissimo-Rodrigues, PhD

Role: CONTACT

+111699963-8236‬

Facility Contacts

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Priscila Goncalves

Role: primary

Francielle Pereira

Role: primary

Debora Pinho

Role: primary

Maite Magdalena

Role: primary

Israel S. Maia

Role: primary

Vivian Irineu

Role: primary

References

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Dale CM, Rose L, Carbone S, Pinto R, Smith OM, Burry L, Fan E, Amaral ACK, McCredie VA, Scales DC, Cuthbertson BH. Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial. Intensive Care Med. 2021 Nov;47(11):1295-1302. doi: 10.1007/s00134-021-06475-2. Epub 2021 Oct 5.

Reference Type RESULT
PMID: 34609548 (View on PubMed)

Price R, MacLennan G, Glen J; SuDDICU Collaboration. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis. BMJ. 2014 Mar 31;348:g2197. doi: 10.1136/bmj.g2197.

Reference Type RESULT
PMID: 24687313 (View on PubMed)

Bellissimo-Rodrigues WT, Menegueti MG, Gaspar GG, de Souza HCC, Auxiliadora-Martins M, Basile-Filho A, Martinez R, Bellissimo-Rodrigues F. Is it necessary to have a dentist within an intensive care unit team? Report of a randomised clinical trial. Int Dent J. 2018 Dec;68(6):420-427. doi: 10.1111/idj.12397. Epub 2018 May 18.

Reference Type RESULT
PMID: 29777534 (View on PubMed)

Bellissimo-Rodrigues F, Bellissimo-Rodrigues WT. Ventilator-associated pneumonia and oral health. Rev Soc Bras Med Trop. 2012 Oct;45(5):543-4. doi: 10.1590/s0037-86822012000500001. No abstract available.

Reference Type RESULT
PMID: 23152333 (View on PubMed)

Zhao T, Wu X, Zhang Q, Li C, Worthington HV, Hua F. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Database Syst Rev. 2020 Dec 24;12(12):CD008367. doi: 10.1002/14651858.CD008367.pub4.

Reference Type RESULT
PMID: 33368159 (View on PubMed)

Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 Jun;43(6):687-713. doi: 10.1017/ice.2022.88. Epub 2022 May 20.

Reference Type RESULT
PMID: 35589091 (View on PubMed)

Marino PJ, Wise MP, Smith A, Marchesi JR, Riggio MP, Lewis MAO, Williams DW. Community analysis of dental plaque and endotracheal tube biofilms from mechanically ventilated patients. J Crit Care. 2017 Jun;39:149-155. doi: 10.1016/j.jcrc.2017.02.020. Epub 2017 Feb 16.

Reference Type RESULT
PMID: 28259058 (View on PubMed)

van Nieuwenhoven CA, Buskens E, Bergmans DC, van Tiel FH, Ramsay G, Bonten MJ. Oral decontamination is cost-saving in the prevention of ventilator-associated pneumonia in intensive care units. Crit Care Med. 2004 Jan;32(1):126-30. doi: 10.1097/01.CCM.0000104111.61317.4B.

Reference Type RESULT
PMID: 14707570 (View on PubMed)

Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, Lynfield R, Maloney M, McAllister-Hollod L, Nadle J, Ray SM, Thompson DL, Wilson LE, Fridkin SK; Emerging Infections Program Healthcare-Associated Infections and Antimicrobial Use Prevalence Survey Team. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014 Mar 27;370(13):1198-208. doi: 10.1056/NEJMoa1306801.

Reference Type RESULT
PMID: 24670166 (View on PubMed)

Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005 Jun;33(6):1266-71. doi: 10.1097/01.ccm.0000164543.14619.00.

Reference Type RESULT
PMID: 15942342 (View on PubMed)

Other Identifiers

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ip_hcor_oracle

Identifier Type: -

Identifier Source: org_study_id

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