The HAPPEN Study
Brushing Up on Prevention: How a Multicentre Randomised Control Trial Reduced Non-Ventilator Hospital-Acquired Pneumonia (NV-HAP) Through Better Oral Care
Why this study is important?
Hospital-acquired pneumonia is one of the most common and serious infections affecting patients in hospital. Poor oral hygiene allows harmful bacteria to build up in the mouth, which can then be inhaled into the lungs and contribute to pneumonia, particularly in vulnerable patients.
Aim: The HAPPEN Study was designed to evaluate whether improving oral care for hospitalised patients could reduce the burden of non-ventilator hospital-acquired pneumonia (NV-HAP) and improve patient outcomes.
The HAPPEN study phases
Our study consists of three phases, summarised below.
Phase 1: Co-Design
Phase 1 laid the foundation for the HAPPEN study through a National Survey and Nurse Focus Groups that explored current oral care practices and identified the most effective approaches to education, resource development, and implementation in hospitals. These findings, together with feedback from consumers, professional associations, and project partners, informed the design and delivery of Phase 2 of the HAPPEN study.
Phase 1 determined:
Phase 2: The HAPPEN study Trial
The HAPPEN Study Trial evaluated a simple oral care intervention involving 8,870 patients across three Australian hospitals. The intervention combined access to toothbrushes and toothpaste, education for patients and staff on the role of oral care in preventing non-ventilator hospital-acquired pneumonia (NV-HAP), assistance for patients requiring support with oral hygiene, and regular feedback to hospital wards.
By increasing oral care rates from 16% to 62%, reducing NV-HAP risk by 60%, and saving hospitals approximately AUD$152 per patient, the intervention demonstrates how a simple, affordable oral care strategy can improve patient outcomes while reducing healthcare costs.
Research from the HAPPEN trial has been published across high-impact journals. Trial outcomes appeared in The Lancet Infectious Diseases, economic evaluation findings in The Journal of Hospital Infection, and qualitative insights from clinician and patient interviews in The Journal of Clinical Nursing, highlighting the trial’s clinical, economic, and patient-centred impact.
Phase 3: Translation
Since the publication of the HAPPEN trial results in The Lancet Infectious Diseases, HAPPEN has been showcased at major national and international conferences, reaching healthcare professionals across nursing, infection prevention and control, and infectious diseases. The study has also attracted significant media attention, featuring in more than 40 news and media reports both in Australia and around the world. Findings from Phase 2 helped provide high-quality evidence for NV-HAP prevention.
Resources used during the trial are now available in the Resources section and include:
We will continue to update and expand these materials as new evidence, implementation insights, and guidance emerge following dissemination of the trial.
Where is the study up to?
Phase 1 and Phase 2 have been successfully completed.
The trial involved 8,870 patients across three Australian hospitals and provides strong evidence that a simple oral care intervention can improve patient outcomes and prevent NV-HAP. Results have been published in The Lancet Infectious Diseases.
Beyond the clinical trial results, findings from the HAPPEN economic evaluation and interviews with healthcare staff and patients have also been published, providing insights into both the value and real-world experience of the intervention.
Phase 3 of the study is currently underway.
The resources used throughout the HAPPEN trial are available to download free of charge in our Resources section.
We will continue to update and expand these materials as new evidence, implementation insights, and guidance emerge following dissemination of the trial.
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