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From left: Francine Leach of the North End Community Health Centre and Shauna Hachey from the Faculty of Dentistry load completed oral health bundles for delivery to the NSHA

A UK-based project gave them the idea and Dr. Rebecca Affoo and Prof. Shauna Hachey from the Healthy Populations Institute (HPI) thought it could be done in Nova Scotia, too: To assemble and distribute oral health care bundles to help intensive care unit nursing staff care for their patients, particularly those on ventilators.

The aim of the project, Dr. Affoo explains, is to support front-line workers in Nova Scotia hospitals during the COVID-19 pandemic. “We want to thank them and help them in the care of their patients in a convenient way. They are the heroes of our community.”

Across the province there are 140 ICU beds, which could rise to 190 beds in the event of a second wave of COVID-19 infections.
 
Intubated patients are at increased risk of bacterial growth in the mouth. Oral tubes keep the mouth open, which often worsens oral dryness. A lack of saliva may lead to increased bacteria growth in the mouth, which can be aspirated into a patient’s lungs, as well as cause a host of tooth, gum, and mouth problems.

The HPI team assembles ICU bundles. From left: Dr. Rebecca Affoo (Faculty of Health), Shauna Hachey (Faculty of Dentistry), Gillian Ritchey (MD, HPI), Christine Ingram (Faculty of Dentistry), Francine Leach (NECHC)

A convenient kit of tools and information
“The idea is that the oral health care bundles will contain everything the ICU staff need in one convenient package that can then be used to improve the quality of life for ICU patients,” says Prof. Hachey. “Some of those patients may have COVID-19, but daily mouthcare for intubated patients is important, regardless of the circumstance.”

The HPI team’s first step was to contact Dr. Craig Dale at the Sunnybrook Health Sciences Centre in Toronto. He and other researchers from Toronto have produced an oral health care guide for mechanically ventilated patients, an ICU mouth care routine poster, and a QR code link to an instructional video. These items are key components in the oral health bundles the HPI team has assembled.

The HPI team also approached companies to obtain the other items needed to complete the kits. These include a soft bristle toothbrush with a cover to guard against the transmission of infection, dry mouth mouthrinse, gel for mouth sores, and lip moisturizer. No toothpaste is included with the kits because it poses an aspiration risk.

“We are grateful to the companies that stepped up to provide supplies for the bundles, including Duckish, a local company that provided 200 full-size lip balms, Oral Science, which provided the toothbrushes, toothbrush covers and Gengigel, and GSK for the Biotène mouthrinse,” says Prof. Hachey.

The HPI team worked with the NS Health Authority’s Partners for Care to deliver the Oral Health Bundles to hospitals around the province. The North End Community Health Centre was also a partner in the project.