- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03886623
A Systematic Oral Care Program in Post-Mechanically Ventilated, Post-Intensive Care Patients
The purpose of this study is to see if a 4 day oral care program in patients who have been on a breathing machine results in better oral health, reduces the amount of certain bacteria in the mouth and reduces infection while in the hospital.
The plan is to test the specific hypotheses that a standardized oral care protocol:
- Results in improved oral health compared to standard care,
- Reduces the rate of Staphylococcus aureus / methicillin resistant Staphylococcus aureus, and
- Reduces the risk of healthcare-associated infections.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Upon meeting inclusion criteria and consenting to participate, the subject will be enrolled in the study. Upon extubation, the subject will be randomly assigned using a computer generated table of random numbers to either the intervention or control group. Daily safety checks including reviewing INR and platelet counts (if performed) will be performed to ensure patient has maintained eligibility for the study.
Study Intervention:
Control Arm:
Current practice in the intensive care units includes the provision of oral care as part of the Ventilator Bundle guideline focused on the reduction of VAP. Currently, the intensive care units utilize a commercially available pre-package oral hygiene kit. This includes mouth care (alcohol free mouthrinse and hydrogen peroxide) with swabs every 2 hours, tooth brushing (suction toothbrush with anti- plaque paste) every 12 hours, deep oral suctioning every 8 hours and prior to ET tube retaping, and chlorohexidine gluconate (15ml) swabbed onto oral surfaces every 12 hours (SICU patients only). Mouth care is documented every two hours.
On the progressive care units and general medical-surgical units, routine oral care is provided as part of the general hygiene care of the units, and based on the clinical determination of the nurse. The selection of oral care techniques currently used on the progressive care units is determined by the level of independence of the patient and oral hygiene needs of the patient. Two techniques are currently being implemented: 1) toothbrushing using a basic toothbrush and basic oral care products provided by the hospital every 12- 24 hours. 2) The prepackaged suctioning kit which includes suction toothbrush with toothpaste and suction oral swabs with alcohol-free mouth rinse, and hydrogen peroxide every 4 hours or based on clinical judgement. Lip moisturizer is applied inside the mouth and on the lips.
Intervention Arm The intervention proposed would include a 4-5 day systematic oral hygiene program provided to patients who are post-extubation. The proposed intervention would begin in the intensive care unit within 24 hours post-extubation and when the patient is determined to be medically stable. The protocol would be initiated with an intensive oral hygiene intervention (see Appendix A) with selected oral hygiene products in the post-extubation period. Following the oral hygiene intervention of the oral cavity, the intervention would continue even if the patient transitions from the intensive care setting to either the progressive care unit or general medical-surgical unit. The intervention will be provided by the Clinical Nurse Specialist (key personnel) from the Division of Critical Care Nursing and Medical-Surgical Nursing. The oral hygiene program will be provided a total of 9 times.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Ohio
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Columbus, Ohio, United States, 43015
- The Ohio State University
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Age 18 years or older
- Has required mechanical ventilation for at least 48 hours
- Meets ventilator liberation criteria (PEEP ≤ 8 and FiO2 ≤ 50%)
- Minimum of 3 teeth
- Either the subject or their Legally Authorized Representative is capable of reading, understanding and providing written informed consent.
Exclusion Criteria:
- Non-English speaking
- Allergy to products/components of the oral care protocol
- Oral or maxillofacial surgery, or oral/facial trauma in last three months
- INR > 3.5 or platelet count < 20,000
- Planned hospital discharge within 48 hours
- Current diagnosis of mucositis, or undergoing chemotherapy or radiation therapy
- Presence of Tracheostomy
- Family or physician not in favor of continued medical treatment.
- Unable to give informed consent, and/or lack of availability of an authorized representative who can provide consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 4-day systematic oral hygiene
The intervention proposed would include a 4-5 day systematic oral hygiene program.
Using a pea-sized amount of Colgate Total Clean Mint Toothpaste with a Battery-operated Oral-B Pro-Health Type 3744 toothbrush, all surfaces, tongue-side, check-side, and biting surfaces of the participants teeth will be brushed.
The tongue will be brushed with a GUM Dual Action Tongue Cleaner and flossing will be done with GUM Flossmate handle and Oral B Guide Floss in between the contacts of each tooth.
The mouth will then be rinsed with Crest Pro-Health mouthwash rinse for 30 seconds twice daily.
A Medline Remedy Phytoplex lip balm will then be applied.
|
he intervention proposed would include a 4-5 day systematic oral hygiene program.
Using a pea-sized amount of Colgate Total Clean Mint Toothpaste with a Battery-operated Oral-B Pro-Health Type 3744 toothbrush, all surfaces, tongue-side, check-side, and biting surfaces of the participants teeth will be brushed.
The tongue will be brushed with a GUM Dual Action Tongue Cleaner and flossing will be done with GUM Flossmate handle and Oral B Guide Floss in between the contacts of each tooth.
The mouth will then be rinsed with Crest Pro-Health mouthwash rinse for 30 seconds twice daily.
A Medline Remedy Phytoplex lip balm will then be applied.
|
Other: Standard of Care oral care
Standard of Care oral care.
Currently, the intensive care units utilize a commercially available pre-package oral hygiene kit.
This includes mouthwash swabbing every 2 hours with Careline Alcohol-Free mouthwash or Sage Alcohol Free mouthwash, teeth brushing (with Sage Toothette Oral Care, Sodium Bicarbonate Toothpaste and Sage Suction Toothbrush) every 12 hours, deep oral suctioning every 8 hours and prior to oral Endotracheal tube (ET) retaping, and Paroex Oral Rinse chlorohexidine gluconate (15ml) swabbed onto oral surfaces every 12 hours (SICU patients only).
Mouth care is documented every two hours.
|
Standard of Care oral care.
Currently, the intensive care units utilize a commercially available pre-package oral hygiene kit.
This includes mouthwash swabbing every 2 hours with Careline Alcohol-Free mouthwash or Sage Alcohol Free mouthwash, teeth brushing (with Sage Toothette Oral Care, Sodium Bicarbonate Toothpaste and Sage Suction Toothbrush) every 12 hours, deep oral suctioning every 8 hours and prior to oral Endotracheal tube (ET) retaping, and Paroex Oral Rinse chlorohexidine gluconate (15ml) swabbed onto oral surfaces every 12 hours (SICU patients only).
Mouth care is documented every two hours.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in prevalence of Methicillin-sensitive Staphylococcus aureus (MSSA) in post mechanically ventilated patients as assessed by Oral cultures (Swabs)
Time Frame: Day 1 and 4 days post-extubation
|
The overall purpose of this project is to develop an evidence-based oral care protocol for acutely ill hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients.
The aim is to assess the impact of an oral care protocol on the following rate of oral colonization with Methicillin-sensitive Staphylococcus aureus (MSSA)
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Day 1 and 4 days post-extubation
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Change in prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) in post mechanically ventilated patients as assessed by Oral cultures (Swabs)
Time Frame: Day 1 and 4 days post-extubation
|
The overall purpose of this project is to develop an evidence-based oral care protocol for acutely ill hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients.
The aim is to assess the impact of an oral care protocol on the following rate of MRSA,
|
Day 1 and 4 days post-extubation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Determine infection rate of healthcare acquired infections (MSSA and MRSA) in post mechanically ventilated patients receiving oral care using nasal cultures (Swabs)
Time Frame: 4 days
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Obtain Data on the incidence of new MSSA and MRSA infections in the post-mechanically, ventilated post-ICU patient using nasal cultures (Swabs)
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4 days
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Identify change in patient satisfaction in post mechanically ventilated patients who receive oral care using a Patient satisfaction survey/interview.
Time Frame: 4 days post extubation
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Assess whether there is an increase in patient satisfaction in those receiving the intervention by using Patient satisfaction survey/interview.
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4 days post extubation
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Identify change in patient quality of life in post mechanically ventilated patients who receive oral care using the Edmonton Symptom Assessment System quality of life assessment tool.
Time Frame: 4 days post extubation
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Measure change in patient quality of life as reported using the Edmonton Symptom Assessment System quality of life assessment tool of 0 to 10 scale, where 0 represents no symptom and 10 represents the worst possible severity.
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4 days post extubation
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Esther Chipps, RN,PhD, Ohio State University
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2011H0015
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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