ESCMID 2026
Better oral care cuts hospital-acquired pneumonia risk
Clinical takeaway: Basic oral care may be an effective hospital prevention strategy for hospital-acquired pneumonia that’s not associated with ventilator use.
Non-ventilator-associated hospital-acquired pneumonia (NV-HAP) is common, serious, and has had less evidence behind prevention strategies than ventilator-associated pneumonia. In a recent trial, investigators tested whether a structured oral care program could lower that risk in routine hospital care
Researchers conducted a multicenter, stepped-wedge cluster randomized controlled trial across nine wards at three Australian hospitals over 12 months. Patients received a toothbrush, toothpaste, education, and online resources at admission, while staff received training, online materials, and onsite support; usual care served as the control.
Hospital-acquired pneumonia incidence fell from 1 to 0.41 cases per 100 admission days at risk, with intervention exposure associated with a 60% lower risk. Oral care delivery rose from 12.6% in the control phase to 65.0% during the intervention. The trial included 8,870 patients, with roughly half exposed during the intervention period.
The findings suggest that a low-tech intervention may meaningfully reduce pneumonia risk in general hospital wards. The practical question now is whether hospitals can implement and sustain structured oral care reliably across busy inpatient settings.
“Typically, NV-HAP is the result of fluids from the mouth or throat entering the lungs, with hospital-associated respiratory pathogens more frequently detected in patients who are unable to clear oral secretions," explained lead study author Professor Brett Mitchell, Avondale University, Australia. "These infections are thought to arise largely from a patient’s own microbiota rather than person-to-person transmission. Improving oral hygiene helps reduce these pathogens in the mouth, potentially lowering the risk of subsequent infection.”
Source: Mitchell B. ESCMID Global 2026. 2026. The hospital acquired pneumonia prevention (HAPPEN) study: a multi-centre randomised controlled trial