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Updated: Aug 1, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Original Research: Oral Care as Prevention for Nonventilator Hospital-Acquired Pneumonia: A Four-Unit Cluster
Karen K Giuliano1, Daleen Penoyer, Aurea Middleton
1Karen K. Giuliano is an associate professor at the College of Nursing and the Institute for Applied Life Sciences, University of Massachusetts Amherst. Daleen Penoyer is the director of the Center for Nursing Research and Advanced Nursing Practice, Orlando Health, Orlando, FL. Aurea Middleton is the research coordinator for Orlando Health's Center for Nursing Research. Dian Baker is a professor at the School of Nursing, California State University, Sacramento. Financial support for this study was provided by Medline Industries (which supplied the kits used) and Orlando Health. Baker and Giuliano have also created a CE program on NV-HAP sponsored by Medline. An intervention toolkit is available from the authors. The authors acknowledge Joohyun Chung for her guidance and review of the statistical approach and analyses. Contact author: Karen K. Giuliano, kkgiuliano96@gmail.com . The authors have disclosed no other potential conflicts of interest, financial or otherwise.
Implementing standardized oral care protocols significantly reduced nonventilator hospital-acquired pneumonia (NV-HAP) rates in acute care settings. Enhanced oral hygiene is a key strategy for preventing patient infections and improving safety.
Area of Science:
- Healthcare quality improvement
- Infectious disease prevention
- Patient safety research
Background:
- Nonventilator hospital-acquired pneumonia (NV-HAP) is a significant patient safety concern in hospitals.
- Emerging evidence suggests oral care interventions can prevent NV-HAP.
Purpose of the Study:
- To evaluate the effectiveness of a standardized oral care protocol in reducing NV-HAP incidence.
- To measure NV-HAP rates per 1,000 patient-days in acute care.
Main Methods:
- A 12-month study involving 8,709 patients across four hospital units (two medical, two surgical).
- Randomized assignment to enhanced oral care (intervention) or usual oral care (control) groups.
- Comparison of NV-HAP incidence rates between intervention and control units.
Main Results:
- Medical units: Enhanced oral care increased frequency (0.95 to 2.25/day), reducing NV-HAP by 85% (OR 7.1 higher in control).
- Surgical units: Enhanced oral care increased frequency (1.18 to 2.02/day), reducing NV-HAP by 56% (OR 1.6 higher in control, not significant).
Conclusions:
- Daily oral care can serve as primary source control for NV-HAP prevention.
- Further research is needed on optimal strategies and oral microbiome changes during hospitalization.
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