Oral Care Protocol Research Articles

Oral Care in ICU Mechanical Ventilation Patients and Associated Pneumonia: A Literature Review

Background: Poor oral health can lead to hospital-acquired pneumonia, a serious condition that can prolong patient care and increase the risk of mortality. The bacteria found in the oral cavity of patients with periodontal disease can be particularly harmful if inhaled into the lungs. Patients who are on mechanical ventilation are at an increased risk of developing aspiration pneumonia. Objective: to investigate the effect of oral care on ventilation associated pneumonia (VAP) and various types of such care. Methods: This review article is performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature exploration was done in PubMed, Embase, and Web of Science databases for articles published between 2011 and 2023. The search words were "Mechanical ventilation, intubation, pneumonia, dental care, oral care and ICU ". Results: A total of 21 studies were included, the studies were randomized controlled trials (RCTs) or quasi-RCTs and observational studies. Twice-daily oral care with tooth brushing using purified water can significantly reduce the incidence of VAP. Oral care with chlorhexidine and brushing, as well as enhanced oral care, can also be effective in reducing the incidence of VAP. Improved education and implementation of oral care protocols with 0.12% chlorhexidine solution can significantly reduce the incidence of VAP. Conclusions: The review concludes that good oral hygiene, especially twice-daily oral care with tooth brushing using purified water, can significantly reduce the incidence of VAP in mechanically ventilated patients.

The Main Effects of the Original Oral Care Protocol Implementation in Patients on Invasive Mechanical Ventilation

Respiratory infection is the most common nosocomial infection found in intensive care units (ICUs). Dental plaques and oral mucosa can be colonized by respiratory pathogens within a few days after tracheal intubation. Oral care plays an important role in reducing the incidence of ventilator-associated infections.Aim of the study. To evaluate clinical effectiveness of the original oral care protocol in ICU patients on invasive mechanical ventilation (IMV).Materials and Methods. A multicenter, open-label, randomized, prospective, controlled study was conducted in 55 surgical ICU patients on long-term mechanical ventilation. Oral care for patients in the study group (group 1, N=30) included brushing with disposable toothbrushes and rinsing with an aqueous solution of 0.05% chlorhexidine digluconate three times daily. In the control group (group 2, N=25), patients' oral care was performed twice a day using sterile cotton swabs soaked in 0.05% aqueous chlorhexidine digluconate solution. The results were statistically processed using IBM SPSS Statistics 21. The relative risk (RR) of events was calculated with a 95% confidence interval (95% CI). The 95% CIs for event density parameters such as incidence rate (IR) and incidence rate ratio (IRR) were calculated using the exact Poisson test.Results. The incidence of ventilator-associated pneumonia (VAP) was 13.6 cases [95% CI: 4.4; 31.7] per 1,000 ventilation days in group 1 and 23.6 cases [95% CI: 7.7; 55] per 1,000 ventilation days in group 2. The incidence of VAP was 1.74 times lower [95% CI: 0.4, 7.54] in group 1 vs. group 2 (P=0.398). The identity of oral and tracheal flora on day 7 was 20% in group 1 and 50% in group 2, RR=0.4, 95% CI: 0.165–0.973, P=0.037. Serum C-reactive protein levels were significantly lower in group 1 on day 7 of ventilation compared to group 2 (P=0.04).Conclusion. The original oral care protocol, based on toothbrushing 3 times daily with a set of disposable toothbrushes and 0.05% aqueous solution of chlorhexidine digluconate, is associated with a tendency to lower VAP incidence per 1000 days of ventilation, significantly lower similarity between oral and tracheal flora, and lower serum C-reactive protein levels on day 7 of IMV. Further research on various aspects of oral care in ICU patients is needed, especially in the absence of complete clinical guidelines and clearly effective strategies for the prevention of ventilator-associated infections.

The Effect of Oral Care Protocols on Mucositis in Pediatric Cancer Patients: A Randomized Controlled Trial

Background/Aims: Standard oral care protocols can reduce the incidence of mucositis. This study aimed to evaluate the effect of the "Oral Care Protocol" containing sodium bicarbonate or saline on mucositis development, degree, and duration in pediatric cancer patients. Methods: This study is a blind, parallel trial design, randomized controlled study. Patients (n = 43) who received inpatient chemotherapy treatment for more than three days at the Pediatric Hematology and Oncology Unit were included. The oral care protocol with saline was given to the patients in the control group (n = 22), and the oral care protocol with sodium bicarbonate was given to the patients in the study group (n = 21). The primary outcome was the development of mucositis. The secondary outcomes were mucositis degree, patient data at the time of mucositis development, and the duration of mucositis. The characteristics of the patients in the study and control groups and the data of patients with and without mucositis were compared with Fisher's exact test, t-test, and chi-square analysis. Results: No statistically significant difference was found between the study and control groups in terms of mean age, gender, diagnosis, relapse status, treatment stage, risk group, and treatment protocols. Mucositis developed in 18.2% of the patients in the control group and 9.5% of the patients in the study group. No statistically significant difference was found in terms of mucositis development, degree, and duration. Conclusions: The oral care protocol with sodium bicarbonate can be used to prevent mucositis in pediatric cancer patients. ClinicalTrials.gov Identifier: NCTXXX.

The Effect of Oral Care Intervention in Mucositis Management Among Pediatric Cancer Patients: An Updated Systematic Review.

Chemotherapy-induced mucositis is inflammation that develops in the oral mucosal due to anticancer treatment. Mucositis has negative consequences that may lead to distress in pediatric patients, resulting in escalated expenses, diminished quality of life, hindrance in cancer therapy, and decreased survival rates. However, despite the numerous methods, oral care protocols are suggested for implementation in the pediatric population despite a lack of high-level evidence studies, particularly regarding which appropriate oral care agents should be administered. This systematic review aimed to identify the effect of oral care intervention in mucositis management among pediatric cancer patients. Studies were published between 2014 and 2023 from five databases: PubMed, Embase, Medline, ScienceDirect, and Scopus. They were identified using a search strategy to identify relevant studies that identify oral care interventions for managing mucositis in children with cancer. This study used the Joanna Briggs Institute (JBI) critical appraisal tools to assess the quality of the studies and followed the recommended reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Eight studies met the inclusion criteria, including seven RCTs and one quasi-experimental study. Oral care interventions involving tooth brushing, mouthwash, and lip care are performed entirely or partially. The frequency of oral care ranges from two to six times daily, and the duration of intervention is from 5 days to six weeks. Oral care interventions using honey, olive oil, Aloe Vera, Andiroba, and salivary enzyme toothpaste are beneficial to lower the severity of mucositis, reduce pain, minimize mucositis duration, and reduce the use of analgesics, but not significantly improve the child's quality of life. However, Caphosol mouthwash did not significantly reduce mucositis. Our study highlights that oral care intervention using effective agents integratively, including honey, olive oil, Aloe vera, Andiroba, and salivary enzyme toothpaste, is essential to manage chemotherapy-induced mucositis among children. PROSPERO registration number was CRD42023456278.

Nation-wide survey of oral care practice in Japanese intensive care units: A descriptive study.

Oral care for critically ill patients helps provide comfort and prevent ventilator-associated pneumonia. However, a standardized protocol for oral care in intensive care units is currently unavailable. Thus, this study aimed to determine the overall oral care practices, including those for intubated patients, in Japanese intensive care units. We also discuss the differences in oral care methods between Japanese ICUs and ICUs in other countries. This study included all Japanese intensive care units meeting the authorities' standard set criteria, with a minimum of 0.5 nurses per patient at all times and admission of adult patients requiring mechanical ventilation. An online survey was used to collect data. Survey responses were obtained from one representative nurse per intensive care unit. Frequency analysis was performed, and the percentage of each response was calculated. A total of 609 hospitals and 717 intensive care units nationwide participated; among these, responses were collected from 247 intensive care units (34.4%). Of these, 215 (87.0%) and 32 (13.0%) reported standardized and non-standardized oral care, respectively. Subsequently, the data from 215 intensive care units that provided standardized oral care were analyzed in detail. The most common frequency of practicing oral care was three times a day (68.8%). Moreover, many intensive care units provided care at unequal intervals (79.5%), mainly in the morning, daytime, and evening. Regarding oral care methods, 96 (44.7%) respondents used only a toothbrush, while 116 (54.0%) used both a toothbrush and a non-brushing method. The findings of our study reveal current oral care practices in ICUs in Japan. In particular, most ICUs provide oral care three times a day at unequal intervals, and almost all use toothbrushes as a common tool for oral care. The results suggest that some oral care practices in Japanese ICUs differ from those in ICUs in other countries.

Oral Complications and Management Strategies for Cancer Patients: Principles of Supportive Oncology in Dentistry.

It is recognized that patients undergoing cancer treatment experience different adverse effects depending on the type of therapy they received. The objective of this work is to provide a scientific evidence-based protocol for oral care in cancer patients. Cancer resection surgery, chemotherapy, and radiotherapy can cause important complications that impact patients' quality of life. Cancer patients, from the moment of diagnosis to the end of treatment and subsequent follow-up, have diverse care needs, both from a systemic and local point of view. The implementation of oral care protocols before, during, and after cancer therapy is essential because it helps to identify risk factors for the development of predictable oral complications. It is essential to establish that all cancer patients, before starting treatment, undergo a systematic dental check-up to avoid limitations during treatment and also alter their quality of life. Regular professional oral care maintenance and follow-up programs are essential to maintaining a patient's long-term oral health.

Impact of Bisphosphonate Therapy on Oral Health in Patients with Breast and Prostate Cancer and Bone Metastases: A Comprehensive Study.

This study investigates the impact of bisphosphonate therapy on the stomatognathic system in 80 patients with cancer of the breast and prostate with bone metastases. Bisphosphonates are integral for managing skeletal complications in these malignancies but are associated with bisphosphonate-related osteonecrosis of the jaw (BRONJ), affecting 0.8-18.5% of patients. BRONJ manifests with pain, neuropathy, tissue swelling, mucosal ulceration, tooth mobility, and abscesses, yet its pathogenesis remains elusive, complicating risk prediction. The research employed comprehensive dental and radiological evaluations. Dental status was assessed using DMFT and OHI-S indices, Eichner's classification, and clinical periodontal measurements like the pocket depth (PD), clinical attachment loss (CAL), and modified Sulcus Bleeding Index (mSBI). A radiological analysis included panoramic X-rays for radiomorphometric measurements and TMJ lateral radiographs. Results indicated a significant decline in oral hygiene in patients with cancer after bisphosphonate therapy, marked by increased DMFT and OHI-S scores. Periodontal health also showed deterioration, with increased PD and CAL readings. The incidence of BRONJ symptoms was noted, although exact figures are not quantified in this abstract. The study also revealed changes in radiomorphometric parameters, suggesting bisphosphonates' impact on bone density and structure. No substantial alterations were observed in TMJ function, indicating a need for extended observation to understand bisphosphonates' long-term effects on the stomatognathic system. These findings highlight the importance of continuous dental monitoring and prophylaxis in patients undergoing bisphosphonate therapy. Implementing meticulous oral care protocols is essential for mitigating BRONJ risk and managing the complex oral health challenges in patients with cancer.

Relationship of Oral Hygiene and Oral Mucositis with Concurrent Chemo-Radiotherapy in Head and Neck Cancers

Background: Oral mucositis is a common and debilitating side effect of concurrent chemoradiotherapy for head and neck cancers, significantly affecting patient quality of life and treatment continuity. Previous studies have highlighted the potential role of oral hygiene in mitigating the severity of mucositis, yet standardized care protocols remain underexplored. Objective: To investigate the relationship between oral hygiene and the incidence and severity of oral mucositis in patients undergoing concurrent chemoradiotherapy for head and neck cancers. Methods: A prospective observational study was conducted over six months at the Oncology Department of Combined Military Hospital, Rawalpindi, with a sample size of 100 patients. Patients aged 18-70 years with histopathologically confirmed head and neck cancers and an ECOG performance status of 2 or less were included. Oral hygiene was assessed using a standardized scale, and mucositis was graded post-therapy using the CTCAE version 5.0 criteria. Data were analyzed using SPSS version 25 with Chi-square tests and ordinal logistic regression. Results: The study found that 44% of patients with poor oral hygiene developed moderate to severe mucositis (grades 2 and 3), compared to 24% with grade 2 and 5% with grade 3 mucositis in the good oral hygiene group. The difference in mucositis severity between the two groups was statistically significant (P < 0.01). Conclusion: The maintenance of good oral hygiene is significantly associated with a lower severity of mucositis in patients receiving concurrent chemoradiotherapy for head and neck cancers. This association suggests that standardized oral care protocols should be an integral part of cancer treatment to improve patient outcomes.

HOLISTIC ORAL CARE FOR CRITICALLY ILL CHILDREN: KNOWLEDGE AND PRACTICES OF INTENSIVE CARE UNIT NURSES

Objective: This research aims to assess the knowledge, perceptions, practices, and education of pediatric critical care nurses regarding oral care for critically ill children. The study addresses the existing gap in evidence-based oral care in this population and emphasizes the importance of understanding these factors for the development of effective oral hygiene practices in pediatric critical care settings. Methods: A descriptive cross-sectional study was conducted between October 2022 and March 2023 in Babylon Governorate. Four hospitals located in Hillah City, Babylon Province, were selected as the study sites. The sample included nurses working in specific critical care units within these hospitals, with a total of 170 nursing personnel participating. Data collection involved the distribution of questionnaires to the nurses, and statistical analysis was performed using SPSS software. The study obtained the necessary administrative and ethical approvals for data collection. Results: The sample consisted of 170 intensive care unit nurses, selected through stratified sampling based on gender (105 female and 65 male). Recruitment for the study commenced in February 2023. The mean score for oral health knowledge was moderate (2.14), However, the oral care practice score was good (2.02). No significant differences were observed in comprehensive mouth care scores based on age and educational qualification. Nevertheless, a significant difference was found in the mean score for complete oral care between male and female nurses (18.37 vs. 17.85, p = 0.021). Moreover, knowledge and practice scores varied significantly based on years of experience. Conclusions: This study provides valuable insights into the knowledge, perceptions, and practices of intensive care unit nurses regarding oral care. Implementation of standardized oral care protocols, along with adequate resources and support, can contribute to enhancing comprehensive mouth care in intensive care units.

Oral hygiene practices and dental care challenges in children with Microcephaly

At the university level, the academic community must understand that, for quality education, it is necessary to carry out extension activities to integrate the training of both teachers and students. But what would extension actions be developed for an extremely vulnerable population, such as children with microcephaly? What would be the oral health care protocol guidelines for these individuals? What would this exchange of knowledge be like between the two groups: university and this vulnerable population? Based on these questions, this article proposes to report the experiences of professors and students of the Dentistry course at the State University of Southwest Bahia about oral health practices and challenges in dental care for children with microcephaly based on the principles of universality, equity and integrality.

The Effect of Regular Oral Care Protocol on Preventing or Decreasing Severity of Oral Mucositis in Acute Leukemia Patient: A Prospective Trail.

This article reports a study designed to evaluate the effectiveness of regular oral care protocol developed specifically for adults in intensive care to prevent mucositis. Data were collected using oral mucositis assessment scale, oral cavity assessment tool, and the National Cancer Institute Common Toxicity Criteria. The results indicated that oral mucositis can be reduced through the practice of administering oral care in accordance with oral health care guidelines. Oral care implemented in line with an evidence-based oral care guide and frequent observation of patients is the most important step in preventing oral mucositis.

The use of a train-the-trainer model to educate non-dental healthcare professionals for oral care

Background: Associations between oral health and systemic conditions have been well established in recent literature. Improvements in oral hygiene have consistently shown to significantly reduce the incidence of respiratory infections, which has high morbidity and mortality rates in the frail elderly. However, the simple low-cost intervention of good oral care remains overlooked in healthcare institutions and nursing homes, due to limited awareness and knowledge. Previous efforts for oral care training of non-dental healthcare professionals have been largely sporadic, with little impact and reach to the medical fraternity. Purpose: To overcome these challenges, we utilized a train-the-trainer model, where seven senior nurses from the long-term stay wards of a public community hospital were educated on the importance of good oral health and trained to administer a comprehensive oral care protocol in patients requiring assistance. The Oral Health Education Programme (OHEP) consisted of a full-day workshop on Common Dental Conditions, Oral Health Assessment Technique (OHAT), and oral hygiene instruction for normal and assisted tooth brushing in independent and mechanically ventilated patients respectively. Results: Majority of the nurses felt that the training was effective and applicable to their work. The number of patients with chronic respiratory infections in the wards were reduced after commencement of OHEP. Conclusion: This interprofessional education collaboration using the train-the-trainer model provides a standardized curriculum, while allowing autonomy for the trainers to customize modules relevant to their respective institutions. This partnership model between medical nurses and oral health professionals allows for better sustainability of the programme.

Effect of fourth hourly oropharyngeal suctioning on ventilator-associated events in patients requiring mechanical ventilation in intensive care units of a tertiary care center in South India: a randomized controlled trial.

Mechanical ventilation (MV) is a necessary life-saving measure for critically ill patients. Ventilator-associated events (VAEs) are potentially avoidable complications associated with MV that can double the rate of death. Oral care and oropharyngeal suctioning, although neglected procedures, play a vital role in the prevention of VAE. A randomized controlled trial was conducted in the intensive care units to compare the effect of fourth hourly oropharyngeal suctioning with the standard oral care protocol on VAE among patients on MV. One hundred twenty mechanically ventilated patients who were freshly intubated and expected to be on ventilator support for the next 72 hours were randomly allocated to the control or intervention groups. The intervention was fourth hourly oropharyngeal suctioning along with the standard oral care procedure. The control group received standard oral care (i.e., thrice a day) and on-demand oral suctioning. On the 3rd and 7th days following the intervention, endotracheal aspirates were sent to rule out ventilator-associated pneumonia. Both groups were homogenous at baseline with respect to their clinical characteristics. The intervention group had fewer VAEs (56.7%) than the control group (78.3%) which was significant at P<0.01. A significant reduction in the status of "positive culture" on ET aspirate also been observed following the 3rd day of the intervention (P<0.001). One of the most basic preventive strategies is providing oral care. Oropharyngeal suctioning is also an important component of oral care that prevents microaspiration. Hence, fourth-hourly oropharyngeal suctioning with standard oral care significantly reduces the incidence of VAE.

Impact of Oral Care for Intensive Care Unit Patient on Pneumonia Infection Prevention: Literature Review Study

Background: Oral cavity bacteria can be mostly harmful if inhaled into the lungs. Hospital acquired pneumonia (HAP), a critical condition that presents clinically two or more days after hospitalization, which may increase the risk of mortality. Lacking oral care can lead to Hospital acquired pneumonia. Objective: to explore effective oral care consequence on hospital acquired pneumonia prevention. Methods: This review article is performed according to the PRISMA guidelines. The literature exploration was done in Google Scholar and PubMed databases for articles published between 2017 and 2020. The search words were “oral care, oral hygiene, intensive care, critical care, ICU, respiratory infection, lung infection, pneumonia, and adult". Results: A total of 6 studies were included, the studies were randomized controlled trials (RCTs) and observational studies. Oral care with tooth brushing and purified water twice daily can significantly reduce the incidence of HAP. Brushing patient mouth with chlorhexidine is also effective in decreasing the HAP incidence. Implementing oral care protocols in ICU with chlorhexidine solution and nurse education can significantly lower the incidence of HAP. Conclusions: Good oral and dental care, particularly with tooth brushing and purified water twice daily, can significantly reduce the incidence of HAP in intensive care unit patients.

Implementation of a nursing oral health care protocol in a university teaching hospital: A cluster-randomized stepped-wedge design.

Providing oral care is an essential part of basic nursing care but receives little priority in daily practice, with a risk of adverse events. Also, nurses report many barriers to adequate provision of oral care, such as time restraints, insufficient materials, fear of causing pain, lack of knowledge and a negative attitude towards providing oral care. We performed a cluster-randomized, stepped-wedge study to explore the effect of the the implementation of a new nursing evidence-based oral care protocol on nurses' knowledge, attitude and protocol adherence. The study population included both nursing students, graduated nurses and patients in selected wards. The implementation strategy included oral and written information, instruction videos and reminders. Nurses' knowledge and attitude towards oral care were assessed at baseline and after the implementation of the protocol with a validated 47-item questionnaire with a score range of 0-100. Secondarily, nurses' protocol adherence to teeth brushing, measured in Activities of Daily Living (ADL) dependent patients, was evaluated. The Standards for Reporting Implementation Studies (StaRI) Statement was used. At baseline, the questionnaire was completed by 226 nurses; after implementation by 283. Knowledge had significantly improved from 68.8 to 72.3. Nurses' attitude improved not significantly. Protocol adherence was assessed in 73 ADL-dependent patients at baseline, in 51 after implementation. Adherence to teeth brushing significantly decreased in patients with permanent teeth. Also, adherence to both teeth brushing and usage of soap decreased in patients with (partial) dentures. Nurses' knowledge and attitude of oral care increased somewhat after the implementation of a new nursing evidence-based protocol. After implementation, there was an unexplained decreased adherence to oral care in ADL-dependent patients.

Provision of Oral Care in the Cardiothoracic Intensive Care Unit: Survey of Nursing Staff Training, Confidence, Methods, Attitudes, and Perceived Barriers.

Poor oral health is associated with adverse outcomes in critical care settings. Although provision of oral care is a fundamental aspect of nursing practice, both formal training and practice among nursing staff remain unclear. Cardiothoracic intensive care unit nurses were recruited to complete a 16-item survey regarding training, confidence, methods, prioritization, and barriers to provision of oral care. A total of 108 nurses participated (70% response rate). Formal training in oral care was reported by 38%, most frequently reported as less than 1 hour (53%) in duration. Of the respondents, 70% reported confidence in providing oral care. Nine methods and 16 products were identified, with variability in the frequency of provision. Prioritization of oral care was rated most frequently as moderate (53%), with 28% reporting barriers. Despite limited formal training, surveyed nurses reported confidence in providing oral care. Methods, frequency, and prioritization were variable. Both development of formal curricula and evaluation of adherence to standardized protocols for oral care are warranted. [J Contin Educ Nurs. 2023;54(7):313-321.].

Effectiveness of supervised implementation of an oral health care protocol on ventilator-associated pneumonia patients in intensive care units: a double-blind multicenter randomized controlled trial

The available scientific evidence suggests a significant association between oral bacteria and the incidence of ventilator-associated pneumonia (VAP). The aim of this study was to determine the effectiveness of an oral health protocol in the prevention of ventilator-associated pneumonia. In this multi-center RCT, conducted in the intensive care units of neurological patients in three general teaching hospitals of two provinces located in the west of the Iran, a consecutive sample of 200 intubated patients were initially recruited. Patients were randomly allocated to the intervention (received oral health care based on evidence-based oral health protocol) or control (routine oral health care) groups. Both groups received their prescribed treatment regimen for seven consecutive days. The percentage of VAP diagnoses as main outcome assessed using clinical pulmonary infection score (CPIS). The rate of VAP in the intervention and control groups was 5% and 64%, respectively. The intervention reduced the risk of VAP by 97% and this difference was statistically significant (P <0.001). The chance of VAP occurrence in patients with lower levels of consciousness in univariate and multivariate analysis was significantly higher (OR: 2.38; 95%CI: 1.11-5.26) P <0.05). The results of our study suggest that the use of a dynamic supervised oral health care guideline is more effective than the routinely used protocols in the intensive care units of hospitals.

Clinical guidance for maintaining oral hygiene in patients under-going chemotherapy or radiation therapy: a scoping review

The aim of this scoping review was to identify clinical guidance for maintaining oral hygiene in patients undergoing chemotherapy, radiation therapy, or both. Electronic searches were conducted in PubMed, Embase, Cochrane Library, and Google Scholar for articles published between January 2000 and May 2020. Systematic reviews, meta-analyses, clinical trials, case series, and expert consensus reports were considered eligible for inclusion. The SIGN Guideline system was used to evaluate the level evidence and the grade of recommendations. A total of 53 studies met the eligibility criteria. The results showed the presence of recommendation for oral care in three domains: management of oral mucositis, prevention and control of radiation caries, and management of xerostomia. However, most of the included studies had low levels of evidence. The review provides recommendations for healthcare professionals caring for patients undergoing chemotherapy, radiation therapy, or both, but a standard oral care protocol could not be established owing to a paucity of evidence-based data.&#x0D; Accepted for publication: February 20, 2023&#x0D; Published online: February, 2022

Oral health care in adult intensive care units: A national point prevalence study.

The importance of good oral hygiene for patients in Intensive Care Units (ICUs) is well recognized, however, the most effective way to achieve good oral care in the ICU is unclear. This study aimed to provide a national picture of oral care practices in adult ICUs in the United Kingdom (UK) to identify areas for improvement. A national one-day point prevalence study was undertaken in adult ICUs in the UK in the period from 30th September to 14th October 2021. Data were collected on all patients in the ICU on the date of data collection. Using a validated electronic data collection form, anonymised data were collected on methods and frequency of oral care provided, and the use of oral care protocols within the ICU. Data were analysed using descriptive analysis. Data from 195 patients in 15 ICUs in England, Wales and Northern Ireland were collected. Written oral care protocols were available for use in the care of 65% (n = 127) of patients. 73% (n = 142) of patients received oral care within the 24-h period. Oral care methods included toothbrushing 41% (n = 79), foam sticks 3% (n = 5), moisturizing the oral cavity 10% (n = 19) and mouth rinse with chlorhexidine 3% (n = 5) and other oral care methods not specified 12% (n = 23). 44% (n = 85) of patients had an oral assessment within the 24-h period and variable assessment methods were used. There is large variability in oral care provision and methods for intubated ICU patients and a lack of consensus was revealed in the study. Oral assessment is conducted less frequently using multiple tools. Optimal oral care standards and further research into oral care provision is pivotal to address this important patient-relevant practice. Oral care is a fundamental part of care for ICU patients, however, there is a large degree of variability, and oral care is often not based upon oral assessment. The use of an oral care protocol and oral assessments would help to improve patient care, ease of use for staff and provide a tailored oral care plan for patients, improving efficiency and preventing wasted resources.

Abstract LB143: Improving treatment outcomes: a digital solution for remote patient monitoring of stomatitis for patients receiving Dato-DXd

Abstract Instances of stomatitis are very painful and compromise nutrition and oral hygiene as well as induce an increased risk for local and systemic infection. Stomatitis is a well-known toxicity of radiotherapy, chemotherapy and other targeted therapies and is associated with dose interruptions, reductions, and treatment discontinuation. For upcoming Dato DXd phase III trials, the mitigation strategies included patient education delivered at the site and supported by printed material to foster continued adherence to an oral care protocol (OCP). The study team thought to leverage digital technology, namely patient-provisioned smartphones to bring the OCP right “to the patients’ fingertips”, while enabling health care providers at the site to monitor onset or worsening of stomatitis for each patient. The digital solution consists of a patient interface for data acquisition and personalized education/behavioral reinforcement, and a clinician interactive data dashboard to access, in real time, patients’ records of stomatitis-related symptoms and their impact on nutrition and hydration, respectively. For a few days post infusion, the solution surfaces personalized illustrated vignettes to provide the participant with simple recommendations for self-care and probe to contact the clinical site team when symptom(s) reach a given morbidity threshold. The clinical team can visualize data on demand or upon being prompted, to quickly assess trends towards stomatitis worsening and decide on the next course of action. This solution for remote patient monitoring of stomatitis risk is deployed in four studies and is planned for an additional three, reaching approximately a total of 7,000 patients across 49 sites in 16 countries. Early feedback from patients confirmed the engaging design, the low burden daily usage, and the perceived utility of the solution. Patients who had experienced stomatitis previously indicated that such a solution would have given them confidence to engage with their site sooner to receive care. Further structured feedback from clinical study teams and analyses of clinical trial data are planned to inform patients’ sustained compliance using the solution and its effectiveness in mitigating high grade of stomatitis and helping patients to better manage their treatment and outcomes. Citation Format: Rebecca H. Wray, Elisabeth Piault, Lucie Miller-Potucka, Jill A. Bell, Rick Fairhurst, Sabrina S. Khan, Micah J. Maxwell, Neelima Denduluri, Leora Horn. Improving treatment outcomes: a digital solution for remote patient monitoring of stomatitis for patients receiving Dato-DXd [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB143.