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Toothbrushing Is a Critical Step in Preventing Hospital-Acquired Pneumonia

It’s simple. It’s inexpensive. It’s widely available in a number of iterations. And it’s a basic daily oral health routine that might save lives

Hospital-acquired pneumonia (HAP), also known as nosocomial pneumonia, is considered the most common infection associated with hospital stays. It is defined as pneumonia that occurs 48 hours or more following admission to a hospital, but that was not present at the time of admission. It’s most often associated with the use of ventilators in intensive care units (ICUs). In fact, it’s thought to affect 10% to 20% of patients who receive mechanical ventilation for more than 48 hours. And more than 90% of pneumonia cases in ICUs occur in intubated or mechanically ventilated patients. It has a high mortality rate.1

This type of pneumonia develops when oral bacteria get into patients’ airways and infect their lungs. Efforts have been ongoing to identify causative factors involved in the development of HAP, which can stem from fungal, viral, and bacterial pathogens. In hospital settings, Staphylococcus aureus is of particular concern. But to date, data on effective prevention strategies have been scant.2,3


Researchers from Harvard Medical School, Brigham and Women’s Hospital in Boston, and the University of Basel in Switzerland recently tackled this problem from a unique perspective. Conducting a systematic review and meta-analysis, they investigated the relationship between daily toothbrushing and HAP.2

The researchers collected pertinent data from across the globe and analyzed the results of 15 randomized clinical trials that included 2,786 hospitalized patients. They considered numerous factors, comparing patients who received mechanical ventilation to those who did not, and those who engaged in various kinds of oral care regimens — with and without toothbrushing — to those who did not.


The study showed that HAP rates were significantly lower in patients who engaged in not just oral care but daily toothbrushing. This was especially the case in those receiving mechanical ventilation. Additionally, toothbrushing was associated with less time on ventilators, as well as shorter stays and lower mortality rates in the ICU.

Commenting on the striking finding, one of the study’s authors, Michael Klompas, MD, MPH, a hospital epidemiologist and an infectious disease physician in the Department of Medicine at Brigham and Women’s Hospital and a professor at Harvard Pilgrim Health Care Institute, noted, “It’s rare in the world of hospital preventive medicine to find something like this that is both effective and cheap. Instead of a new device or drug, our study indicates that something as simple as brushing teeth can make a big difference.”3

The study results led the researchers to conclude that programs and policies encouraging daily toothbrushing are warranted, particularly in ICU patients and those on mechanical ventilation.

Said Klompas, “The findings from our study emphasize the importance of implementing an oral health routine that includes toothbrushing for hospitalized patients. If patients cannot perform the task themselves, we recommend a member of their care team assist.”3


  1. Shebi E, Gulick PG. Nosocomial pneumonia. StatPearls.
  2. Ehrenzeller S, Klompas M. Association between daily toothbrushing and hospital-acquired pneumonia: A systematic review and meta-analysis. JAMA Intern Med.
  3. Brigham and Women’s Hospital. Toothbrushing tied to lower rates of pneumonia among hospitalized patients.
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