About the HAPPEN Trial
What is the HAPP Trial?
A multi-centre randomised control trial exploring the effectiveness of improving the frequency and quality of oral care, in reducing the incidence of pneumonia, and is registered with the Australia New Zealand Clinical Trial Registry.
How is it funded?
This project is funded by a Medical Research Future Fund grant (Prof Brett Mitchell) following a national competitive grant process and is administered by Avondale University. Academic project partners at Cabrini Health, Monash University, Australian Catholic University, the Queensland University of Technology. Our industry partners are the Australian College of Nursing, Sigma Nursing, Central Coast Local Health District, Mid-North Coast Local Health District, Clinical Excellent Commission (NSW) and the Australasian College for Infection Prevention and Control
Why is it needed?
In Australia, we have estimated 160,000 patients contract a Healthcare-associated Infection (HAI) every year. Non-ventilator hospital-associated pneumonia (HAP) is the most common type of HAI, accounting for approximately one third of these infections, with an estimated 50,000 patients affected each year in Australian public hospitals alone. In Australian public hospitals, we have estimated that the burden of HAP is 15,684 disability adjusted life years annually – more than any other HAI. HAP is associated with increased length of stay in hospital, increased morbidity, mortality, and healthcare costs
Is there not enough evidence already?
Remarkably, despite this burden, HAP receives little attention from policymakers and researchers. HAP is both underreported and understudied. This research will address a critical health service need being experienced both nationally and internationally, increasingly important because bacterial pathogens that cause pneumonia have become increasingly difficult to treat due to increasing antimicrobial resistance. Antimicrobial resistance poses a catastrophic threat to health and the community. Identifying ways to prevent infections such as HAP are therefore critical and aligned with national priorities such as Australia’s National Antimicrobial Resistance Strategy – 2020.
Why the focus on oral hygiene in this study?
HAP usually occurs because of aspiration of the patients’ own oropharyngeal material. Hospital respiratory pathogens are more commonly found in the mouths of those who are unable to clear their secretions. Based on a systematic review, we know which interventions may help reduce the risk of HAP. One key intervention that may reduce HAP is improving the quality and frequency of oral care. HAP is associated with prior oral carriage with common hospital pathogens, which reinforces the need for improvements in oral care. Reducing oral colonisation of hospital pathogens improves patient oral hygiene and the risk of HAP. For a variety of reasons oral care may currently not be performed optimally in hospitals. A robust clinical trial is needed to help inform clinical practice, policy and education. In our clinical trial, we will test the effect of improving the quality and frequency of oral care on reducing the incidence of HAP