Associations between routine oral care and in-hospital mobility with non-ventilator hospital-acquired pneumonia.

Abstract

Objective: Non-ventilator hospital-acquired pneumonia (NV-HAP) is common and deadly. Guidelines recommend improving oral care and mobility performance to prevent NV-HAP but data on their impact are limited. We therefore evaluated associations between oral care and mobility performance with NV-HAP and mortality rates in a large hospital network.

Design: Retrospective cohort study.

Setting: 144 acute care hospitals.

Patients: Adults hospitalized for ≥4 days between May 2021 and July 2023.

Methods: We extracted daily data on oral care performance (yes, no) and patient mobility (bed-bound, upright, walking) and used time-varying Cox proportional hazards models to evaluate associations between oral care and mobility performance with NV-HAP and in-hospital mortality risk, adjusting for patients' demographics, comorbidities, hospital service, daily vital signs, and daily laboratory measures.

Results: Among 1,744,811 hospitalizations (9.6 million hospital-days), median patient age was 68 (IQR 55-78) and 50.6% were female. Persistent oral care for ≥3 days was associated with 16% less NV-HAP (hazard ratio (HR) 0.84; 95% CI: 0.82-0.86) and 6% lower mortality (HR 0.94; 95% CI: 0.92-0.96), with stronger effects in the ICU than outside the ICU. Persistent walking for ≥3 days was associated with 18% less NV-HAP (HR 0.82; 95% CI: 0.79-0.85) and 80% lower hospital-mortality (HR 0.20; 95% CI: 0.19-0.21), with stronger effects outside the ICU than in the ICU.

Conclusions: In a large hospital network, both oral care and mobility were associated with lower risk of NV-HAP and hospital mortality, with differential effects inside and outside of the ICU. Prospective trials are needed to confirm these potential benefits.