Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Multi-centred, Stepped Wedge, Cluster Randomised Controlled Trial to Compare the Clinical and Cost Effectiveness of a Complex Oral Health Care Intervention and Standard Oral Health Care in Stroke Care Settings: a Phase II Pilot Trial.
Brief Summary: Stroke associated pneumonia (SAP) affects a fifth of stroke survivors annually, tripling the risk of death at 30 days and contributing to poorer rehabilitation outcomes, prolonged hospital stays and dependency at discharge. Systematic review evidence indicates that enhanced oral health care (OHC) has a preventative effect on the incidence of pneumonia amongst nursing home populations (absolute risk reductions 6.6% to 11.7%; numbers needed to treat 8.6 to 15.3 individuals). There are strong theoretical reasons to suggest similar benefits might be observed in stroke care settings but current empirical evidence is weak - trial quality (randomisation, blinding, sample size, reporting), intervention description and thus feasibility of translation into clinical practice is very poor. Following an extensive pre-clinical programme of work, investigators now plan the pilot phase (Phase II) of a stepped-wedge cluster RCT of a well-developed and defined complex OHC intervention versus usual OHC. Investigators aim to establish a robust web-based randomisation process, refine the proposed intervention (training, tools, equipment), recruitment, adherence, record linkage and sampling methodologies. Investigators also aim to establish the relationship between SAP and plaque and any diversity between sites.


Options:
A: Inclusion Criteria:

* Adults \> 18 years
* Closed head trauma with a Glasgow Coma Score \<=8 or cerebral Hemorrhage with a Glasgow Coma Score of \<=8
* Expected need mechanical ventilation for \>=2 days
* Written informed consent from the patient's next-of-kin. If no relative is present at the time of inclusion, the patients will be included according to the emergency procedure

Exclusion Criteria:

* Impossibility to perform oropharyngeal decontamination within 12 h following the initial episode
* Facial injury with impossibility to perform the oropharyngeal decontamination
* Tetraplegia
* Known history of reaction to iodine
* Respiratory disease or pulmonary infiltrate(s) at inclusion
* Need for curative antibiotics
* Mercurial antiseptics treatment
* Pregnancy
B: Inclusion Criteria:

* Aged 50 years and over
* Moderate to severe stroke (Barthel Index \>/= 70)
* Admitted to Rehabilitation Unit within 7 days

Exclusion Criteria:

* Patients with naso-gastric feeding tube
* Edentulous patients
* Patients with communication difficulties
C: Inclusion Criteria:

* All patients admitted to stroke care settings.

Exclusion Criteria:

* Consent declined.
D: Inclusion Criteria:

* long term care resident of nursing home
* residents age \>65
* residents of nursing home for at least one month
* residents having at least one of two modifiable risk factors for pneumonia (i.e., impaired oral hygiene, swallowing difficulty)

Exclusion Criteria:

* residents housed in nursing home for short term rehabilitation
* residents who receive nourishment by tube feeding
* residents who have a life expectancy \< 3 months
* residents who have been diagnosed with pneumonia within the previous 6 weeks
* residents who are currently using oral chlorhexidine
* residents who have previously been enrolled in the study
* residents, or their designated proxies, who are unwilling to give informed consent
* residents who have tracheostomy
* residents who are non-english speaking
* residents who the administrator leadership of the home felt were not appropriate for the study

Answer: C