A large-scale pilot clinical trial has been conducted by a network of trainee anaesthetists across the South West for the first time, thanks to support from the South West Anaesthesia Research Matrix (SWARM) and PenCLAHRC.
The trial was designed to assess whether a comprehensive oral hygiene regime could decrease the risk of post-operative pneumonia for patients undergoing major elective abdominal surgery.
Funded by an NIAA grant, the randomised control trial ‘CUPPA’ (Comprehensive moUth care and Post-operative PneumoniA) was delivered across six NHS hospital sites by more than 45 trainee clinicians specialising in anaesthesia, all members of the SWARM collaboration.
Data collection and analysis for the trial was coordinated by PenCLAHRC SWARM Fellow, Dr Tori Field, anaesthetic trainee at Derriford Hospital, Plymouth. PenCLAHRC funding and support has allowed her one day a week of protected research time to take a leading role in the trial.
As a PenCLAHRC SWARM Fellow, Dr Field, who is mentored by Dr Gary Minto, Consultant Anaesthetist at Plymouth Hospitals NHS Trust, has gained experience of project management and collaborative working. She said of the scheme:
“PenCLAHRC support has been invaluable in allowing me protected research time to run activities for this project. Through SWARM and PenCLAHRC I have had access to expert advice about research methodology, including qualitative research, about which many hospital doctors know little.”
Inhaling secretions from the throat is one of many factors that can contribute to patients developing pneumonia after an operation. Previous research has shown that reducing concentrations of pathogenic microorganisms in the mouth, using an antiseptic such as chlorhexidine, may make patients less likely to develop pneumonia in critical care, as well as reducing pneumonia in nursing home residents.
Patients in the trial’s intervention group were given 0.2% chlorhexidine mouthwash to use daily along with “disclosing” (food dye) tablets to stain up their dental plaque so they could brush it all off with 1% chlorhexidine toothpaste.
Pilot data from the trial is currently undergoing full analysis and will be available soon. Some of the early findings and lessons learnt have been incorporated into the trial design for a national multicentre study endorsed by the NIAA Clinical Trials Network, to explore the effect of administering a chlorhexidine mouthwash prior to anaesthesia, on the recovery of patients following major abdominal surgery.
By running the CUPPA trial in parallel across six sites, the SWARM trainees were able to obtain a meaningful volume of results quickly, while tailoring their involvement around their clinical commitments. They also gained valuable experience of working in conjunction with NIHR Clinical Research Network nurses and administrators.
Through coordinating cross-hospital projects like CUPPA, SWARM aims to help trainee clinicians to overcome challenges that can prevent them from developing their research skills. Working on short-term rotations at a range of hospitals means trainee clinicians often lack the time and connections to attract research funding or take on leading roles in research projects.
All trainees said their involvement in CUPPA had been beneficial, with 96% stating that they now had a better understanding of how a randomised controlled trial is conducted and 72% expressing an interest in setting up their own study in the future.
One of the anaesthetic trainees said:
“I have more understanding of the amount of work it took to set up something like this, and that's just implementation at a local site…It was good experience of co-ordinating and communication with lots of different healthcare professions.”