Dr. Craig Dale has been awarded funding by the Network for Canadian Oral Health Research and the Canadian Lung Association in support of his project: A multi-centered stepped wedge cluster randomized controlled trial (RCT) of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for ventilated critically ill patients (The CHORAL study)”.
In intensive care units (ICUs) across Canada, a special mouthwash is used to reduce mouth germs that cause lung infection in critically ill patients treated with mechanical ventilators. However, new research shows the special mouthwash may cause a sore mouth, does not reduce lung infection, and may increase the risk of death in some patients. There is an urgent need to change oral care to safeguard against these problems. The CHORAL study aims to evaluate a new oral care protocol on the outcomes of mortality, respiratory infections, and oral pain in patients treated with mechanical ventilators.
Dr. Dale and a team of interprofessional co-investigators (including physicians, nurses, pharmacists & dentists) are running the study across six university-affiliated ICUs throughout the city of Toronto. The researchers will conduct a randomized controlled trial in which these ICUs will stop using the special mouthwash and start using good oral care (e.g., tooth brushing) on different dates. ICU staff will be provided with education and other resources to support the change in oral care. Over the course of 14 months, lung infections & ICU deaths will be tracked to determine if removing the special mouthwash and focusing on good oral care better protects patients using mechanical ventilators from harm.
At the end of the study, Dr. Dale & co-investigators hope to offer their educational tools & findings to other ICUs across Canada to improve oral and respiratory health outcomes for patients treated with breathing machines.