Fever Clinical Trial
The purpose of the investigators project is to examine if the investigators may affect a
reduction in respiratory infections in a pediatric long term care facility by institution of
a comprehensive oral care program. The investigators wish to base their project on work such
as of Yoneyama et al 2002, which hypothesized and showed that "silent" aspiration of
oropharyngeal contents is a causative factor in development of respiratory infection in
elderly institutionalized clients. It was found that an advanced oral hygiene program greatly
reduced the incidence of respiratory infection. Although no similar research projects were
found to have involved children, the investigators hope that a similar program of oral care
will allow the investigators to likewise reduce the incidence of respiratory infection among
the pediatric clients in our facility.
The investigators propose to examine two groups of children which are fed by gastrostomy
feedings only. One group will continue to receive oral care as performed today. The study
group will have their teeth brushed three times a day by the nursing staff by using a suction
connected toothbrush, daily examination of the oropharynx by the nursing staff, and use of
chlorhexidine varnish or another suitable antibacterial agent in the oropharynx.
The investigators will retrospectively examine our records (a 12 month period) for febrile
days, antibiotic use and hospitalization days due to respiratory causes. The investigators
will then compare these to the febrile days, antibiotic use and hospitalizations to the 12
month period [post implementation of the oral care program.
The importance of this program is to examine whether by implementation of a relatively
inexpensive and low-tech intervention may meaningfully reduce the morbidity and mortality due
to respiratory infection among our clients (which from our experience is the main cause of
morbidity and mortality in the investigators institution). The investigators expect that by
reducing the incidence of respiratory disease among our clients that the investigators will
greatly reduce suffering among the children and their families, improve their quality of life
and ease the financial and organizational burdens as a result of caring for respiratory
infections.
As was noted before, no prior research was found which studied the pediatric population in a
long term care facilities. It is our belief that this project represents a unique research
opportunity which may bring great benefit to the children and caregivers.
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