A scoping review of oral care protocols for preventing non-ventilator hospital-acquired pneumonia in hospital settings (part 1): defining protocol components and implementation strategies.

BACKGROUND: Non-ventilator hospital-acquired pneumonia (NV-HAP) is prioritised in infection prevention due to its associated mortality and economic burden. Oral hygiene care has been identified as a key preventive intervention.

AIM: To synthesise evidence on oral care protocols for preventing NV-HAP, with a focus on their components and implementation strategies.

METHODS: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Six databases and grey literature sources were searched up to January 2026.

RESULTS: A total of 124 articles were included, comprising 36 evidence synthesis and recommendation sources and 88 clinical and implementation studies. Across these articles, oral care protocols comprised four components: assessment and triage, mouth cleaning (toothbrushing and oral rinsing), oral moisturising, and denture care. Toothbrushing was universally recommended, whereas the use of chlorhexidine was inconsistent. Implementation strategies included staff training, collaboration with dental services, involvement of patients and families, and interdisciplinary teamwork. Embedding oral hygiene within broader interdisciplinary prevention approaches-such as dysphagia management, nutritional support, and early mobilisation-was identified as a key strategy.

CONCLUSION: Oral hygiene is a cornerstone of NV-HAP prevention. The identified protocol components and implementation strategies provide a basis for clinical guideline development and quality improvement initiatives.