Mouth cAre to Prevent Pneumonia in older people Study (MAPPS)
Research type
Research Study
Full title
Mouth cAre to Prevent Pneumonia in older people Study (MAPPS): a feasibility study
IRAS ID
291778
Contact name
Victoria Ewan
Contact email
Sponsor organisation
South Tees Hospitals NHS Foundation Trust
Duration of Study in the UK
1 years, 5 months, 31 days
Research summary
Research summary- Hospital acquired pneumonia (HAP) is the commonest healthcare associated infection in Europe. Up to 70% of patients with HAP may die. HAP occurs because certain bacteria start to live in the mouth when patients become unwell and travel to the lungs. Patients with HAP stay on average an extra 12 days in hospital which is unpleasant for patients and costly for the NHS.
Research suggests frequent mouth care might prevent pneumonia whilst in hospital. However the evidence is not strong enough to make changes to clinical care. A large trial is therefore needed, but some initial work is required to guide successful design and delivery.
This is a feasibility study, aiming to investigate the training, delivery and fidelity of the intervention, with particular emphasis on patients with delirium/dementia, and investigate collection of outcomes for a larger study.
Four wards (3 trusts) which admit patients with hip fracture (and some medical patients) will participate. We will work with clinical teams to understand usual mouth care, provide mouth care training and learn how best to integrate the intervention into routine practice.
The sites will be randomised to start the mouth care intervention every three months apart. Patients will receive three times a day tooth/tongue/denture brushing with an antiseptic mouthwash and recorded by trained healthcare assistants. Interviews will be held with staff and patients to record experiences of delivering and receiving mouth care.
Primary outcome:
Proportion of mouth care episodes delivered out of eligible episodesSecondary outcomes:
Time to achieve maximum mouth care in each unit and feasibility of delivery in this patient population including patients lacking capacity
Feasibility of recruitment, specifically those groups lacking capacity to consent
Completeness of data for cost effectiveness analysis
Completeness of data on episodes of HAP including antibiotic prescriptions
Acceptability to patients/carers/staff assessed by themes from interviews and observations of mouth careSummary of results- Four sites agreed to take part, however, due to significant staff and patient-related challenges as result of the COVID-19 pandemic only two proceeded to set-up with delays. An additional site was sought and agreed to participate in the interviews only. Overall, two sites recruited to the intervention, and three sites participated in interviews.
226 patients were recruited, predominantly female (64.2%), 80 years old on average, 30% had comorbid dementia, 24% had a 4AT score suggesting possible delirium (of those scores available) and 40% consented under a personal or nominated consultee. Of the 226, 35% had completed/partially completed the initial mouthcare assessment prior to commencing the intervention, with their average oral health score rated as “healthy”, while over 75% were not mobile to the sink.
Due to poor documentation of the mouthcare intervention regarding intervention duration, total potential mouthcare episodes could only be. Daily mouthcare delivery was analysed for 198 patients, (27 were missing; one patient was consented in error) with potential mouthcare episodes, documented as completed for 20.8% of episodes and only partially completed for 1.7%, the majority was not recorded (69.3%). These proportions did not significantly change for patients lacking capacity. Most patients did not achieve a mean of twice daily mouthcare during their time on the ward, due to high proportions of undocumented mouthcare episodes. Overall, 12.8% of patients were diagnosed with HAP/chest infection during their inpatient stay.
Receiving the mouthcare was accepted by patients, with no disadvantages of taking part identified. There was variation between patients’ understanding of MAPPS, some felt a bit unsure about what to do, reporting little support from staff. For others, MAPPS raised their awareness of the importance of oral hygiene and considered whether their usual routine was “sufficient”.
Most staff felt confident in delivering MAPPS after the training. However, others felt more training was required around providing MAPPS to the patients lacking capacity, stating these patients could be difficult as they would often refuse or would complain whilst it was being done.
Many staff viewed mouthcare as part of their role on the ward and felt that MAPPS could have great benefits for their patients. Ultimately, capacity played a large role in staff’s ability to deliver the intervention as per the study protocol. If they were busy or short staffed, MAPPS was sacrificed at the expense of more urgent tasks. Staff voiced issues around the MAPPS documentation requirement as it was seen as an added task that was easily forgotten and not prioritised, especially when they were busy. In contrast, when capacity was not an issue, many felt MAPPS did not add greatly to their workload as personal care with patients was routine. Though staff felt that the lunchtime delivery was the hardest to remember as it was not routine.
REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
21/YH/0242
Date of REC Opinion
25 Nov 2021
REC opinion
Further Information Favourable Opinion