Effectiveness of toothbrushing as a replacement for chlorhexidine in oral care, combined with head elevation for the prevention of ventilator-associated pneumonia in intensive care units: interrupted time-series analysis
Authors' conclusion
Implementation of toothbrushing-based oral care combined with reinforced HOBE was followed by lower VAP incidence in the primary ITS analysis
Study context
- Population
- Adult ICU patients in eight intensive care units (ICUs) of a 2,734-bed tertiary care hospital in Seoul, South Korea8 adult ICUs
- Comparison
- Pre-intervention vs Post-intervention
- Outcome
- Monthly VAP incidence rate
- Follow-up
- August 2022 through November 2024
Methodological detailsbefore-after, 8 adult ICUs, tertiary care hospital
- Before-after
- 8 adult ICUs
- Tertiary care hospital
Main finding
As reported in the abstract
Monthly VAP incidence (ITS analysis)
Pre-intervention ventilator-associated pneumonia (VAP) rate: 66 cases during 16,849 device-days
3.9 per 1,000 device-days
Post-intervention VAP rate: 78 cases during 32,185 device-days
2.4 per 1,000 device-days
Further findings
Head-of-bed elevation (HOBE) adherence
- HOBE adherence increased significantly from 84 to 95% after the intervention, P < 0.001
VAP incidence, sensitivity analyses
- Alternative transition windows and negative binomial models: directionally consistent post-intervention declines
- Fully covariate-adjusted interrupted time-series (ITS) model: estimates attenuated and not statistically significant
Original publication
Effectiveness of toothbrushing as a replacement for chlorhexidine in oral care, combined with head elevation for the prevention of ventilator-associated pneumonia in intensive care units: interrupted time-series analysis. Crit Care. Published 6 March 2026. doi:10.
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