Enhanced oral care reduced hospital-acquired pneumonia in randomized trial

“Providing oral care in hospitals is often deprioritized in busy environments."

By
Meg Barbor
August 17, 2026
4 min

MDSpire News

Objective:

To evaluate the effectiveness of an enhanced oral-care program in reducing non-ventilator hospital-acquired pneumonia (NV-HAP) among hospitalized adults.

Approach:

Study Design: The HAPPEN trial was an open-cohort, stepped-wedge, cluster-randomized trial conducted across nine wards in three Australian hospitals.
Intervention: The intervention included oral-care products, education for patients and staff, and support from dedicated research nurses.
Control: Control conditions involved standard oral care without additional products or education.
Participants: Adults aged 18 years or older admitted for at least 48 hours were included, with a total of 8,870 patients analyzed.

Key Findings:

NV-HAP was confirmed in 78 patients, with 46 cases (1%) under control and 32 cases (0.7%) under intervention.
The intervention was associated with a 60% lower hazard of NV-HAP (hazard ratio 0.40; 95% CI, 0.19–0.82).
No reduction was observed in other respiratory infections or infections of the eye, ear, nose, throat, or mouth.
Oral-care protocol completion increased from 15.8% under control to 61.9% under intervention.
A total of 8,870 patients were analyzed, with a mean age of 72.5 years.

Interpretation:

The study provides evidence that enhanced oral care can significantly reduce the risk of NV-HAP in hospitalized patients.

Limitations:

The trial had a small number of clusters and short intervention periods.
It did not reach its planned sample size and had limited microbiologic confirmation.
Vaccination status and antimicrobial duration were not collected, and baseline antimicrobial use differed between groups.
The reliance on dedicated research nurses may not be feasible for routine implementation.