Pneumonia Clinical Trial
Official title:
Improving Oral Care to Reduce Hospital Acquired Pneumonia (HAP) in the Acute, Non-Intubated, Care Dependent, Neurologically Impaired Adult Patient Population
Hypothesis: The investigators hypothesize that the current oral protocol is sub-optimal and an enhanced protocol will decrease the incidence of hospital acquired pneumonia (HAP)in the acute, non-intubated, care-dependent, neurologically impaired, adult patient.
Overview Problem: Hospital-acquired pneumonia (HAP) is the second most common nosocomial
infection and is a significant cause of morbidity and mortality. In the surgical population,
HAP is associated with a 55% increase in length of stay and increased costs of approximately
$31,000.00 per case. Neurologically impaired patients (those with brain injury causing
alterations in mental status, immobility, impaired swallowing and cough, and increased risk
of aspiration) are particularly vulnerable to HAP. HAP negatively impacts patient comfort
and satisfaction, increases costs associated with diagnostic tests and treatments, increases
risk for sepsis, and potential for higher level of care. It is estimated 95% of
care-dependent patients on the Royal Columbian Hospital (RCH) neuroscience unit acquire HAP
during their stay.
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.
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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