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CompletedNCT03382730CHORALUpdated May 9, 2022

De-adoption of Oral Chlorhexidine Prophylaxis and Implementation of an Oral Care Bundle (CHORAL)

An interventional study of Chlorhexidine Mouth Rinse and Chlorhexidine Mouth Rinse De-Adoption in Mortality, Oral Health and Dryness, Mouth, sponsored by University of Toronto. Completed at 5 sites in Canada. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2022-05-09.

Sponsored by University of Toronto · Not applicable, Interventional, and Prevention

Phase
Not applicable
Study type
Interventional
Enrollment
3,260
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Where this study stands

Counted across the records on this site · 2026-11-12

Among 10 studies in Xerostomia with a site in Canada — none open to participants now, 1 under way, none of them phase 3. Xerostomia · Canada.

Started
2017
with 1 other
No phase
2 of 10
none open now
Registered
8th of 10
by date
Lead sponsor
1 of 10
University of Toronto

Among the 10 studies in Xerostomia with a site in Canada, this one is one of 2 that started in 2017, is one of 2 with no phase, and was the 8th registered.

Xerostomia

286 studies on the registry are indexed under Xerostomia; 51 are open to participants now.

Browse Xerostomia studies →

Open to participants now

None of the 10 studies in Xerostomia with a site in Canada is open now. The open studies under Xerostomia, anywhere →

Who these studies take

Of the 26 Xerostomia studies recruiting now, 15 (58%) set no upper age limit and 7 (27%) stop at 75 or younger; 2 take children under 18; 5 take healthy volunteers.

This study: 18 Years and older · all sexes · no healthy volunteers.

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Download CSVNarrow it in search →With an account: the 10 studies in Xerostomia with a site in Canada as a file.
02

Study summary

The objective of the CHORAL study is to evaluate the de-adoption of oral chlorhexidine and the introduction of a bundle of oral care practices on selected outcomes in critically ill mechanically ventilated adults.

Read the detailed description

Infrequent or ineffective oral care can lead to mouth discomfort and lung infection for patients treated with ventilators (breathing machines) in intensive care units (ICUs). A commonly used mouthwash called chlorhexidine can reduce lung infection but most recent evidence shows it may increase the risk of death. In this study 6 participating intensive care units (ICUs) will de-adopt oral chlorhexidine and introduce a bundle of oral care practices using a multi-faceted educational tool kit. The investigators will measure changes in patient-oriented outcomes including mortality, ventilator-associated complications (VACs) and oral health status. A concurrent process evaluation will study how the intervention is delivered and received by patients and clinicians..

03

Conditions studied

  • Mortality
  • Oral Health
  • Dryness, Mouth
  • Pain, Orofacial
04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • All patients who receive mechanical ventilation in the participating ICUs.

Exclusion criteria

Exclusion Criteria:

  • Does not meet inclusion criteria.
05

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Outcomes assessor)
Enrollment
3,260 participants (actual)

Study arms

  • Other
    Oral Chlorhexidine Mouth Rinse

    Application of chlorhexidine gluconate mouth rinse per unit protocol.

    Other: Chlorhexidine Mouth Rinse

  • Experimental
    De-Adoption of Oral Chlorhexidine Mouth Rinse

    No application of chlorhexidine gluconate mouth rinse. Oral care bundle.

    Other: Chlorhexidine Mouth Rinse De-Adoption

Interventions

  • OtherChlorhexidine Mouth Rinse

    Oral chlorhexidine gluconate oral rinse

    Also known as: Chlorhexidine

  • OtherChlorhexidine Mouth Rinse De-Adoption

    Multifaceted education and audit/feedback.

    Also known as: De-adopt chlorhexidine

06

What researchers measure

Primary outcomes

  1. Intensive Care Unit (ICU) Mortality

    All-cause mortality at time of ICU discharge

    Time frame: 14 months

Secondary outcomes

  1. Infection-related ventilator-associated complications (IVACs)

    Changes in IVACs rates between groups

    Time frame: 14 months

  2. Beck Oral Assessment Score (BOAS), Modified

    Changes in oral health between groups. Scores range from 5 (normal) to 20 (severe dysfunction).

    Time frame: 14 months

  3. Critical Care Pain Observational Tool (CPOT)

    Changes in oropharyngeal pain between groups. CPOT scores range from 0-8 with a score \>2 indicating presence of pain.

    Time frame: 14 months

  4. Oral Dryness - Numeric Rating Intensity Scale (NRS)

    Changes in oral dryness scores between groups. NRS scores range from 0 (no dryness) to 10 (severe dryness).

    Time frame: 14 months

07

Study locations

5 sites
  • Mount Sinai Hospital
    Toronto, Ontario, Canada
  • St. Michael's Hospital
    Toronto, Ontario, Canada
  • Sunnybrook Health Sciences Centre
    Toronto, Ontario, Canada
  • Toronto General Hospital
    Toronto, Ontario, Canada
  • Toronto Western Hospital
    Toronto, Ontario, Canada
08

References and documents

Publications

  • Dale CM, Rose L, Carbone S, Smith OM, Burry L, Fan E, Amaral ACK, McCredie VA, Pinto R, Quinonez CR, Sutherland S, Scales DC, Cuthbertson BH. Protocol for a multi-centered, stepped wedge, cluster randomized controlled trial of the de-adoption of oral chlorhexidine prophylaxis and implementation of an oral care bundle for mechanically ventilated critically ill patients: the CHORAL study. Trials. 2019 Oct 24;20(1):603. doi: 10.1186/s13063-019-3673-0. PubMed 31651364 ↗
  • Dale CM, Rose L, Carbone S, Pinto R, Smith OM, Burry L, Fan E, Amaral ACK, McCredie VA, Scales DC, Cuthbertson BH. Effect of oral chlorhexidine de-adoption and implementation of an oral care bundle on mortality for mechanically ventilated patients in the intensive care unit (CHORAL): a multi-center stepped wedge cluster-randomized controlled trial. Intensive Care Med. 2021 Nov;47(11):1295-1302. doi: 10.1007/s00134-021-06475-2. Epub 2021 Oct 5. PubMed 34609548 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Dec 2017 to primary completion in Jan 2019, 13 months.

Of 85 non-industry interventional studies with no phase under Xerostomia, half reached primary completion within 16 months of starting (the median), counting those still running; a quarter within 7 and three quarters within 33. This study's 13 months is below that.

Counting every sponsor, half of 101 studies reached it within 13 months; a quarter within 4 and three quarters within 33.

How these figures are worked out, and which studies are left out of them.

Registered
Oct 19, 2017
First posted
Dec 26, 2017
StartActual
Dec 1, 2017
Primary completionActual
Jan 31, 2019
CompletionActual
Jan 1, 2020
Last update
May 9, 2022
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on May 9, 2022, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03382730
Collaborators
Sunnybrook Health Sciences Centre, Toronto General Hospital, University Health Network, Toronto, Unity Health Toronto, MOUNT SINAI HOSPITAL
Responsible party
Craig M. Dale (Principal Investigator, University of Toronto) — Principal investigator
First posted
Dec 26, 2017
Start date
Dec 1, 2017
Primary completion
Jan 31, 2019
Completion
Jan 1, 2020
Last update
May 9, 2022

Study contacts

Brian Cuthbertson, MD FRCA
principal investigator · Sunnybrook Health Sciences Centre
Craig Dale, RN PhD
principal investigator · Sunnybrook Health Sciences Centre; University of Toronto

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in May 2022. You cannot join it, but the record below documents what was studied.

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