A scoping review of oral care protocols for preventing non-ventilator hospital-acquired pneumonia in hospital settings (Part 2): factors influencing the implementation of oral hygiene care.

BACKGROUND

Hospital-acquired pneumonia has gained increasing attention among healthcare-associated infections, particularly non-ventilator hospital-acquired pneumonia (NV-HAP). Oral hygiene care is recognised as a key preventive strategy in clinical guidelines.

AIM: The aim of this study was to identify factors influencing the implementation of oral care practices for preventing NV-HAP in hospital settings.

METHODS

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

RESULTS

A total of 177 articles were included. Implementation factors were identified at three levels: organisational, provider, and patient. At the organisational level, key factors included oral care guidance, oral care training, availability of oral care products, staffing and collaboration, and hospital support systems (i.e. infrastructure, support by oral health professionals, and audit function). At the provider and patient levels, shared factors included attitudes, awareness, knowledge, and skills, with additional factors being the providers' prioritisation and the patients' conditions, respectively. These levels were interconnected, highlighting the need for comprehensive, multi-level approaches to support oral hygiene care in hospital settings.

CONCLUSION

The findings, which were consistent across general wards and intensive care units, may support the development of context-specific strategies to enhance oral care practices in clinical care.