title: Development and feasibility testing of an oral hygiene intervention for stroke unit care.
abstract: OBJECTIVE
  To develop an oral hygiene complex intervention and evaluate its feasibility in a single UK stroke centre.
  
  
  BACKGROUND
  Oral hygiene interventions might improve clinical outcomes after stroke but evidence-based practice is lacking.
  
  
  METHODS
  We used a sequential mixed methods approach and developed an oral hygiene complex intervention comprising: (i) web-based education and 'hands-on' practical training for stroke unit nursing staff, (ii) a pragmatic oral hygiene protocol consisting of twice-daily powered (or manual if preferred) brushing with chlorhexidine gel (or non-foaming toothpaste) ± denture care. We evaluated feasibility of (i) the staff education and training and (ii) the oral hygiene protocol in consenting inpatients with confirmed stroke, requiring assistance with at least one aspect of personal care.
  
  
  RESULTS
  The staff education and training were feasible, acceptable and raised knowledge and awareness. Several barriers to completing the education and training were identified. The oral hygiene protocol was feasible and well-tolerated. 22% of eligible patients screened declined participation in the study. Twenty-nine patients (median age = 78 year; National Institutes of Health Stroke Scale score = 8.5; 73% dentate) were recruited at a median of 7 days from stroke onset. 97% of participants chose the default chlorhexidine-based protocol; the remainder chose the non-foaming toothpaste-based protocol. The mouth hygiene protocol was administered as prescribed on 95% of occasions, over a median duration of 28 days. There were no adverse events attributed to the oral hygiene protocol.
  
  
  CONCLUSIONS
  Our oral hygiene complex intervention was feasible in a single UK stroke centre. Further studies to optimise patient selection, model health economics and explore efficacy are now required.
authors.affiliation: Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, UK.|Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: Craig J
authors.identifier: http://orcid.org/0000-0002-9078-9919
authors.initials: CJ
authors.lastname: Smith
authors.affiliation: Faculty of Health Studies, School of Nursing, University of Bradford, Bradford, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Horne
authors.affiliation: School of Dental Sciences, Newcastle University, Newcastle, UK.
authors.forename: Giles
authors.initials: G
authors.lastname: McCracken
authors.affiliation: The Greater Manchester School for Dental Care Professionals (MANDCP), Salford, UK.
authors.forename: David
authors.initials: D
authors.lastname: Young
authors.affiliation: Patient, Carer and Public Involvement Group, North West Stroke Research Network, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Clements
authors.affiliation: Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Hulme
authors.affiliation: Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Ardron
authors.affiliation: Centre for Gastrointestinal Sciences, Institute of Inflammation and Repair, University of Manchester, Manchester, UK.
authors.forename: Shaheen
authors.initials: S
authors.lastname: Hamdy
authors.affiliation: Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK.
authors.forename: Andy
authors.initials: A
authors.lastname: Vail
authors.affiliation: Edinburgh Dental Institute, University of Edinburgh, Edinburgh, UK.
authors.forename: Angus
authors.initials: A
authors.lastname: Walls
authors.affiliation: Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, UK.|Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
authors.forename: Pippa J
authors.initials: PJ
authors.lastname: Tyrrell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene / Q000193:education / Q000379:methods; D016730:Program Development; D000071939:Stroke Rehabilitation / Q000379:methods*
keywords: complex intervention; education.; oral hygiene; stroke