None listed
Conditions
Brief summary
Why this study is important? Healthcare-associated infections (HAIs) are acquired as a direct or indirect result of healthcare. Infections associated with healthcare are not inevitable, and prevention programmes have been successful at reducing the incidence of some HAIs. In Australia, we have estimated 160,000 patients contract a HAI annually. Furthermore, one in ten patients today have an infection acquired in hospital. Non-ventilator hospital-associated pneumonia (HAP) is the most common type of HAI, accounting for approximately one third of these infections, with an estimated 50,000 patients affected each year in Australian public hospitals alone. HAP is associated with increased length of stay in hospital, increased morbidity, mortality, and healthcare costs.Approximately 19% of patients with HAP require transfer into an intensive care unit (ICU), with mortality reported at 18%. Patients with HAP are eight times more likely Our study will: Evaluate the effectiveness and cost-effectiveness of the intervention Develop educational and digital resources and evaluate these as part of the trial Estimate excess length of stay in hospital associated with HAP Describe the patient’s experience of a having a HAP Understand the clinician’s experience of implementing the intervention Assess the impact of HAP on quality of life
Interventions
We will develop a multi-modal intervention that aims to improve the frequency and quality of oral care for patients in hospitals. This intervention will be developed in consultation with healthcare professionals and consumers. Clinical evidence from the literature will be used to help design the intervention strategy. The three pillars of the intervention include oral care, education, and audit/feedback.
1. Oral care
During the intervention, every patient on the ward will be assisted with oral
We will develop a multi-modal intervention that aims to improve the frequency and quality of oral care for patients in hospitals. This intervention will be developed in consultation with healthcare professionals and consumers. Clinical evidence from the literature will be used to help design the intervention strategy. The three pillars of the intervention include oral care, education, and audit/feedback. 1. Oral care During the intervention, every patient on the ward will be assisted with oral care by a nurse. Oral care includes cleaning of the teeth/dentures, tongue, moisturising the lips, using toothbrushes suitable for elderly populations, and toothpaste containing sodium bicarbonate. The goal is for oral care to be performed twice a day, increasing to 4-hourly in participants who are nil by mouth or require assistance with oral care (dependent participants). An oral care pack (containing a toothbrush and sodium bicarbonate toothpaste) will be offered to all hospitals, improving the ease of use. It is not mandatory for patients to use the provided pack, it is provided as an optional resource to aid the intervention. The patient will be encouraged and reminded to undertake oral care by the study and nursing team; for dependent participants, a suction toothbrush may be used, with oral care provided by nursing staff, supported by the study team (research nurse). 2. Education For Staff Face-to-face education and educational resources (developed in our foundation work) for nursing staff will be provided immediately before the intervention phase and reinforced during the intervention. A nurse on the study team will assist in disseminating educational resources to staff on the participating wards. The initial training session will be run by a nurse on the research team, and consist of a 30-min face-to-face session with nursing staff on the wards, to describe the project and how to use the oral care pack. The nurse employed by the study will be available for training and/or to answer questions weekdays during the intervention, thus there is no limit to the frequency/duration of education provided. Additional training sessions will be run as needed, depending on the need (example: a face-to-face 10 min training session to refresh training on the technique of providing oral care). For patients The face-to-face education for patients will be delivered by a nurse on the research team with the appropriate qualifications and experience. The education topics covered include: why improving oral care may reduce the incidence of pneumonia, the correct technique of oral care, where to find information and resources (for example, the study website). This nurse will be available on the ward weekdays during the intervention, thus there is no limit to the frequency/duration of education provided. Resources Additional online resources will be made available to participating wards that cover the topics covered in the face-to-face education sessions. Examples of these include: a video explaining why improving oral care may reduce the incidence of pneumonia, a video of a nurse providing oral care to a patient, a link to the study website and a flyer that describes the relationship between oral care and pneumonia. The use of resources will be available for all patients and staff, but will not be monitored. The online resources will be designed specifically for this study, in co-design with consumers and clinicians. 3. Audit/feedback Adherence to the intervention will be monitored electronically by reviewing hospital notes and recording when patients/nurses performed oral care. The nurse employed by the study team will have the ability to record when patients performed, or were assisted with oral care. Nurses can also record when the supplied oral care pack is given to patients, to help monitor stock levels. Audit results will be used to inform further informal face to face education and training. Additional reports will be provided for internal committees, such as the Infection Prevention and Control committee, as required. Ongoing education will be based on a behaviour change model – based on information obtained during the trial regarding how many times a day patients perform oral care. The nurses employed by the research team will provide monthly feedback on the number of cases of HAP and compliance with the intervention to nursing staff. This will be face-to-face or via email, depending on the preference of the nursing staff. Adherence to the education, for example following correct technique of oral care, will not be audited.
Sponsors
Avondale University
Study design
Allocation
Randomised controlled trial
Primary purpose
Prevention
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
The eligible hospital will meet the following criteria: • classified as a “Public acute group A hospital” by the Australian Institute of Health and Welfare and • have an intensive care unit and • have on average, over 50,000 admissions each year and Three Australian hospitals categorised by the Australian Institute of Health and Welfare as either a principal referral hospital, public hospital (Group A) or private hospital (Group A) will participate in the study. We will randomly select three eligible wards, within each hospital. Wards will qualify for inclusion if they have one or more of the following characteristics enabling the recruitment of participants at greater risk of HAP: medical ward, stroke ward, patients with an average age greater than 70 years. Eligible wards must have a turnover of approximately 150 patients per month.
Exclusion criteria
Exclusions include: any unit that cares for ventilated patients, paediatric, neonatal, adolescent, mental health, medical admission units and wards managing specific respiratory conditions e.g., COVID-19.
Outcome results
None listed