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.

Conclusion:

The findings support the importance of oral care in preventing NV-HAP.

Sources:

• The Lancet Infectious Diseases