Letter to the Editor| Volume 83, ISSUE 3, P381-412, September 2021

Mouth care matters – A HAP prevention strategy


      • Hospital acquired pneumonia (HAP) is the most prevalent healthcare associated infection in the UK, placing a significant burden on healthcare with an associated increase in mortality and hospital length of stay.
      • At University Hospitals Birmingham NHS Foundation Trust (UHB), using a dental nurse reduced the prevalence of non-ventilated-HAP (NV-HAP) on several wards by delivering basic mouth care education to healthcare workers.
      • A Poisson regression model of the number of NV-HAPs demonstrated that the mean number of HAPs per 1000 bed days on four wards before the intervention was 63.5, whilst after the intervention it was 5.95, comprising a 90.63% reduction (p = 0.03851).
      • In conclusion, a basic mouth care intervention by a dental nurse may reduce NV-HAP. Given this promising data, further studies are required to investigate the efficacy of this intervention on a larger scale.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mohd Sazlly Lim S.
        • Zainal Abidin A.
        • Liew S.M.
        • Roberts J.A.
        • Sime F.B
        The global prevalence of multidrug-resistance among Acinetobacter baumannii causing hospital-acquired and ventilator-associated pneumonia and its associated mortality: a systematic review and meta-analysis.
        J Infect. 2019; 79: 593-600
      1. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR), Public Health England 2017 available at: (last accessed on 30th April 2021).

        • Passaro L.
        • Harbarth S.
        • Landelle C.
        Prevention of hospital-acquired pneumonia in non-ventilated adult patients: a narrative review.
        Antimicrob Res Infect Control. 2016; 14: 43
        • Giuliano K.K.
        • Baker D.
        • Quinn B.
        The epidemiology of nonventilator hospital-acquired pneumonia in the United States.
        Am J Infect Control. 2018; 46: 322-327
        • Quinn B.
        • Baker D.L.
        • Cohen S.
        • Stewart J.L.
        • Lima C.A.
        • Parise C.
        Basic nursing care to prevent nonventilator hospital-acquired pneumonia.
        J Nurs Scholarsh. 2014; 46: 11-19
      2. Public Health England (PHE). Delivering better oral health: an evidence-based toolkit for prevention. March 2017 available at: Delivering_better_oral_health.pdf ( (last accessed on 13th May 2021).

      3. European Centre for Disease Control (ECDC). Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Protocol version 5.3, ECDC 2016-2017 available at: (last accessed on 30th April 2021).

      4. R version 4.0.3 (2020-10-10) – The R Foundation for Statistical Computing.

        • El-Rabbany M.
        • Zaghlol N.
        • Bhandari M.
        • Azarpazhooh A.
        Prophylactic oral health procedures to prevent hospital-acquired and ventilator-associated pneumonia: a systematic review.
        Int J Nurs Stud. 2015; 52: 452-464
        • Azarpazhooh A.
        • Leake J.L.
        Systematic review of the association between respiratory diseases and oral health.
        J Periodontol. 2006; 77: 465-482