***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background Nonventilated hospital-acquired pneumonia ( NVHAP ) is a serious nosocomial infection that is increasingly attributed to antibiotic-resistant bacteria . Methods This is a retrospective case-control study comparing patients with and those without NVHAP from January 1 , 2014 to December 31 , 2014 at Barnes-Jewish Hospital , a 1,300-bed urban academic medical center in St. Louis , Missouri . Results One hundred seventy-four consecutive patients with NVHAP were enrolled . A r and om sample of 696 control patients matched by age , sex , race , and hospital admission date were selected from a total of 5,322 potential matched control subjects . NVHAP was pathogen-negative in 98 cases ( 56.3 % ) . Respiratory viruses were identified in 42 patients ( 24.1 % ) , gram-negative bacteria were seen in 25 patients ( 14.4 % ) , and gram-positive bacteria were identified in 20 patients ( 11.5 % ) . Individuals in whom NVHAP developed were more likely to die ( 15.5 % vs 1.6 % ; P < .01 ) , to require intensive care ( 56.3 % vs 22.8 % ; P < .01 ) or mechanical ventilation ( 19.0 % vs 3.9 % ; P < 0.01 ) , and to have a longer hospital length of stay ( 15.9 days [ range , 9.8 - 26.3 days ] vs 4.4 days [ range , 2.9 - 7.3 days ] ; P < 0.01 ) . This case-control study identified a strong association between hospital mortality and NVHAP , with patients who acquired NVHAP having an 8.4 times greater odds of death ( 95 % CI , 5.6 - 12.5 ) . Conclusions The occurrence of NVHAP was associated with significant increases in mortality , the use of intensive care and mechanical ventilation , and hospital length of stay . We also found that respiratory viruses were an important cause of NVHAP . These findings suggest that efforts aim ed at the successful prevention of NVHAP could improve patient outcomes and reduce health-care costs ABSTRACT Hospital-acquired pneumonia ( HAP ) contributes greatly to patient mortality and healthcare costs . Studies have shown that aggressive oral care in intensive care units ( ICUs ) can significantly reduce pneumonia rates , and hospitals have implemented stringent protocol s in this setting . However , little is known about the effectiveness of aggressive oral care in reducing HAP in non – intensive care wards , prompting us to conduct a nonr and omized controlled clinical trial . A structured toothbrushing program was provided to an experimental cohort of patients . A control group received usual care .  Patient demographics , toothbrushing frequency , and pneumonia diagnosis were recorded over a 3.5-month period . Difference in pneumonia rates was computed using unadjusted and multivariate logistic regression analyses . No significant difference in pneumonia rates between control and experimental groups was found ( 1.7 % versus 1.8 % ) . Toothbrushing rates increased significantly in the experimental group ( p = .002 ) but fell short of protocol frequency . It became apparent that aggressive toothbrushing program implementation requires nursing-led interdisciplinary involvement , more intensive training , a streamlined documentation system , and efficient compliance tracking . Lessons from this study should be used for future large-scale research . A secondary analysis of these data did , however , suggests that increasing toothbrushing rates may have the potential to reduce pneumonia in the non-ICU acute care setting OBJECTIVES Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia . We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people . DESIGN Survey . SETTING Eleven nursing homes in Japan . PARTICIPANTS Four hundred seventeen patients r and omly assigned to an oral care group or a no oral care group .  INTERVENTION Nurses or caregivers cleaned the patients ' teeth by toothbrush after each meal . Swabbing with povidone iodine was additionally used in some cases . Dentists or dental hygienists provided professional care once a week . MEASUREMENTS Pneumonia , febrile days , death from pneumonia , activities of daily living , and cognitive functions . RESULTS During follow-up , pneumonia , febrile days , and death from pneumonia decreased significantly in patients with oral care . Oral care was beneficial in edentate and dentate patients . Activities of daily living and cognitive functions showed a tendency to improve with oral care . CONCLUSION We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To evaluate the effectiveness of oral health promotion interventions on clinical oral health . DESIGN Single-blind r and omized controlled trial conducted over 3 weeks of in-hospital rehabilitation . SETTING Stroke rehabilitation ward in Hong Kong . PARTICIPANTS Patients with stroke ( N=102 ) admitted to the rehabilitation ward . INTERVENTIONS Patients were r and omly assigned either : ( 1 ) oral hygiene instruction , ( 2 ) oral hygiene instruction and chlorhexidine mouthrinse , or ( 3 ) oral hygiene instruction , chlorhexidine mouthrinse , and assisted brushing . MAIN OUTCOME MEASURES Dental plaque , gingival bleeding , and oral functional status were assessed at baseline and review . Development of infectious complications were also monitored during the clinical trial . RESULTS Poor oral hygiene and an overall neglect of oral hygiene practice s were observed at baseline . Reductions in dental plaque were significantly greater in the 2 groups receiving chlorhexidine compared with the group receiving oral hygiene instruction alone ( P<.001 ) . Reductions in gingival bleeding scores were 3- to 4-fold greater in groups receiving chlorhexidine . No cases of pneumonia were observed during the course of the clinical trial . CONCLUSIONS The oral health condition of patients may be safeguarded after acute stroke with the use of chlorhexidine mouthrinse in conjunction with a st and ard mechanical plaque removal tool , such as an electric toothbrush . These interventions are acceptable to the majority of patients , and their administration poses a minimal burden to rehabilitation ward staff BACKGROUND Pneumonia remains an important public health problem among elderly nursing home residents . This clinical trial sought to determine if a multicomponent intervention protocol , including manual tooth/gum brushing plus 0.12 % chlorhexidine oral rinse , twice per day , plus upright positioning during feeding , could reduce the incidence of radiographically documented pneumonia among nursing home residents , compared with usual care . METHODS This cluster-r and omized clinical trial was conducted in 36 nursing homes in Connecticut . Eligible residents > 65 years with at least 1 of 2 modifiable risk factors for pneumonia ( ie , impaired oral hygiene , swallowing difficulty ) were enrolled . Nursing homes were r and omized to the multicomponent intervention protocol or usual care . Participants were followed for up to 2.5 years for development of the primary outcome , a radiographically documented pneumonia , and secondary outcome , a lower respiratory tract infection ( LRTI ) without radiographic documentation . RESULTS A total of 834 participants were enrolled : 434 to intervention and 400 to usual care . The trial was terminated for futility . The number of participants in the intervention vs control arms with first pneumonia was 119 ( 27.4 % ) vs 94 ( 23.5 % ) , respectively , and with first LRTI , 125 ( 28.8 % ) vs 100 ( 25.0 % ) , respectively . In a multivariable Cox regression model , the hazard ratio in the intervention vs control arms , respectively , was 1.12 ( 95 % confidence interval [ CI ] , .84 - 1.50 ; P = .44 ) for first pneumonia and 1.07 ( 95 % CI , .79 - 1.46 , P = .65 ) for first LRTI . CONCLUSIONS The multicomponent intervention protocol did not significantly reduce the incidence of first radiographically confirmed pneumonia or LRTI compared with usual care in nursing home residents . CLINICAL TRIALS REGISTRATION NCT00975780 INTRODUCTION The purpose of this point-of-care study was to test the efficacy of a prevention-based oral care protocol in reducing non-ventilator-associated hospital-acquired pneumonia in a neurosurgical population outside the critical care environment . The research ers hypothesized that an enhanced oral care protocol would decrease the incidence of pneumonia . METHODS This quasi-experimental , comparative study took place on an acute neurosurgical unit at a tertiary care trauma hospital in Western Canada . Subjects were non-intubated , care-dependent adults with a primary diagnosis of neurologic injury/insult , and at high risk for pneumonia . The prospect i ve study group comprised 34 subjects ; two subjects were excluded from the study analysis . The retrospective study group comprised 51 subjects . Data were collected for both groups for a six-month period . Retrospective data were collected through chart review . The prospect i ve group were eligible neurosurgical patients who received the enhanced oral care protocol .  Data collection tools were developed and diagnostic criteria for hospital-acquired pneumonia were determined . The pneumonia rates between subjects who received st and ard oral care  ( retrospective group ) and those who received an enhanced , prevention-based , oral care protocol ( prospect i ve group ) were compared . RESULTS A statistically significant decrease in the pneumonia rate occurred in the prospect i ve group ( p < 0.05 ) . DISCUSSION An enhanced oral care protocol was beneficial in reducing the incidence of non-ventilator-associated hospital-acquired pneumonia . IMPLICATION S Nurses play a vital role in preventing hospital-acquired pneumonia . Foundational nursing practice s , such as regular oral hygiene , are important aspects of care in preventing nosocomial infections and related costs , optimizing health , and promoting quality care OBJECTIVE We evaluated the effectiveness of professional oral health care ( POHC ) given by dental hygienists once a week for 24 months to 141 elderly persons needing daily care and living in 2 nursing homes . STUDY DESIGN Elderly subjects with POHC and without POHC living in 2 nursing homes were examined for 24 months to detect any fevers of 37.8 degrees C or more and the prevalence of fatal aspiration pneumonia . The numbers of Staphylococcus species and C and ida albicans in swab sample s from oral cavities were compared between the POHC group and the non-POHC group . The amounts of methylmercaptan exhaled in the POHC group were determined and compared with those in the non-POHC group . RESULTS The prevalence of fevers of 37.8 degrees C or more in the subjects receiving POHC was significantly lower than in the non-POHC group ( P < .05 ) . We found that the ratio of fatal aspiration pneumonia in the POHC group during the 24 months was significantly lower than in the non-POHC group ( P < .05 ) . Numbers of C albicans species in sample s obtained from the oral cavity after 6 months of POHC were significantly lower than those in the non-POHC group ( P < .01 ) . POHC result ed in the reduction of the presence of Staphylococcus but not to a statistically significant extent . The amounts of methylmercaptan exhaled by the POHC group were significantly less than those of the non-POHC group ( P < .05 ) . CONCLUSION This study showed that POHC administered by dental hygienists to a group of elderly patients needing daily nursing care was associated with a reduction in prevalence of fever and fatal pneumonia Background A point‐prevalence survey that was conducted in the United States in 2011 showed that 4 % of hospitalized patients had a health care – associated infection . We repeated the survey in 2015 to assess changes in the prevalence of health care – associated infections during a period of national attention to the prevention of such infections . Methods At Emerging Infections Program sites in 10 states , we recruited up to 25 hospitals in each site area , prioritizing hospitals that had participated in the 2011 survey . Each hospital selected 1 day on which a r and om sample of patients was identified for assessment . Trained staff review ed medical records using the 2011 definitions of health care – associated infections . We compared the percentages of patients with health care – associated infections and performed multivariable log‐binomial regression modeling to evaluate the association of survey year with the risk of health care – associated infections . Results In 2015 , a total of 12,299 patients in 199 hospitals were surveyed , as compared with 11,282 patients in 183 hospitals in 2011 . Fewer patients had health care – associated infections in 2015 ( 394 patients [ 3.2 % ; 95 % confidence interval { CI } , 2.9 to 3.5 ] ) than in 2011 ( 452 [ 4.0 % ; 95 % CI , 3.7 to 4.4 ] ) ( P<0.001 ) , largely owing to reductions in the prevalence of surgical‐site and urinary tract infections . Pneumonia , gastro 
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Conclusions Study results suggest that professional dental care may confer some benefit among NVAP patients .
The lack of consistent OCI protocol s , data in hospitalised patients and robust r and omised clinical trials do not allow definitive conclusions about the contribution of OCI in mitigating NVAP risk