RecentRCT

HAPPEN

Effectiveness of oral care for the prevention of non-ventilator hospital-acquired pneumonia (HAPPEN): a multicentre, stepped-wedge, cluster-randomised trial in Australia

The Lancet. Infectious diseases, 2026 · Stepped-wedge cluster randomized trial across nine wards

Population: 8,870 analyzed adult admissions at three hospitals
Intervention: Enhanced oral care, education, products, audit and feedback
Comparator: Usual care
Primary outcome: Non-ventilator hospital-acquired pneumonia
Result: NV-HAP was 0.7% versus 1.0%; adjusted cumulative HR 0.40 (95% CI 0.19–0.82).

What the trial found

NV-HAP was 0.7% versus 1.0%; adjusted cumulative HR 0.40 (95% CI 0.19–0.82).

Clinical interpretation

Support oral-care implementation for NV-HAP prevention. The bundled ward intervention does not prove benefit from chlorhexidine or establish the same effect in ventilated ICU patients.

Limitations

Apply only to the source-defined population and outcomes; full protocol/subgroup details were not verified for every report.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Hospital-Acquired Pneumonia (HAP)

Nosocomial pneumonia developing ≥ 48 hours after admission in non-ventilated patients, host and antibiogram MDR risk tailoring, nasal MRSA PCR screening, and 7-day de-escalation.

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