It only took a toothbrush, toothpaste and a desire to improve the care of Veterans. With those three things, Shannon Munro, Ph.D., NP, and her team began saving lives by assisting Veterans with their oral care, dramatically reducing rates of non-ventilator associated hospital acquired pneumonia (NV-HAP). The success of HAPPEN (Hospital Acquired Pneumonia Prevention by Engaging Nurses) led to the formation of the National Organization for NV-HAP Prevention (NOHAP) a VA-led effort to reduce NV-HAP across the country in both VA and private sector hospitals, improving patient safety, saving lives and money.

VA has successfully shown patients who brush their teeth a few times a day can dramatically reduce the risk of pneumonia,” said VA Chief Officer of Health Care Innovation and Learning Ryan Vega, MD. “The practice may also reduce the severity of a COVID-19 infection by lowering the probability of a secondary bacterial pneumonia – a frequent occurrence seen with the virus.”

Each year it is estimated that more than 35 million patients in the U.S. are at risk for NV-HAP, at a cost of $3 billion. Pneumonia is an infection that can lead to severe illness and even death. Germs in an unclean mouth multiply rapidly and may trickle down into the lungs during sleep causing pneumonia. Brushing regularly is a simple way to reduce the risk of pneumonia by helping to reduce these germs.

HAPPEN encourages patients to practice consistent oral hygiene (e.g. toothbrushing 2-3 times a day and nightly denture cleaning) through patient education, monitoring of NV-HAP cases, and tracking oral care documentation. When originally launched in 2016 at the Salem VAMC it led to an impressive 92% decrease in the rate of NV-HAP on the long-term care units in year one. Since then, the program has spread to 111 VA facilities with the support of the Diffusion of Excellence, Office of Nursing Services, and the Quality Enhancement Research Initiative – with an average decrease in pneumonia rates of 40–60 percent.

VA, along with its partners, launched NOHAP to bring this life saving practice outside of VA by implementing effective NV-HAP prevention strategies to improve patient safety, enhance quality of life, and save lives across the U.S. Joining us in this work is a network of health care organizations including: The Joint Commission, the Centers for Medicare & Medicaid Services, the American Dental Association, the Health Resources and Services Administration, the Patient Safety Movement Foundation, private industry, and academia.

“This is a simple solution to a costly problem,” said Director of CDC’s Division of Healthcare Quality Promotion Denise Cardo, MD. “The most recent CDC data shows hospitals are succeeding in their efforts to eliminate certain types of health care-associated infections. However, the prevalence of pneumonia in hospitalized patients has not changed and continues to be the most common health care-associated infection.”

To learn more about HAPPEN and its impact on Veterans: https://www.va.gov/INNOVATIONECOSYSTEM/views/solutions/happen.html.


Blake Henderson is the director of the Diffusion Excellence. 

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One Comment

  1. David Clayton March 12, 2021 at 4:11 pm

    Its amazing that something so simple can be so effective!

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