ABSTRACT
Aim
To assess the effect of an educational intervention on nursing professionals' knowledge of hospital oral hygiene and associated factors.
Methods
A single‐group quasi‐experimental study was conducted in a hospital in southern Brazil, including 138 nursing professionals (mean age: 35.46 ± 9.49 years). The intervention comprised three stages: a pre‐test, a protocol‐based educational session delivered by two dental surgeons, and a post‐test. Data were analyzed using descriptive statistics, McNemar's test, and Pearson's chi‐square test (α = 0.05).
Results
Before the intervention, 19.6% of participants had never received academic instruction on oral hygiene, 59.4% had not received institutional training, and 37.7% were unaware of an institutional protocol. After the intervention, correct answers reached ≥95% in 15 of 19 items and 100% in four items (p < 0.001). The greatest improvements were observed for oral hygiene before bathing intubated patients (43.5% to 85.5%), and toothbrush use in hospital settings (52.9% to 85.5%). Higher baseline knowledge was associated with the presence of an institutional oral hygiene protocol (p < 0.05).
Conclusion
The educational intervention improved nursing professionals’ knowledge of hospital oral hygiene. Institutional protocols were associated with higher baseline knowledge, reinforcing the importance of continuing education and standardized protocols to support safe, evidence‐based care.
Keywords: health education, hospital, intensive care unit, knowledge, nursing staff, oral hygiene, professional training
1. Introduction
1.1. Background
Oral health is intrinsically linked to overall well‐being, playing a significant role in hospital settings, where it is common to find immunocompromised patients or those using invasive devices for ventilatory support. In this scenario, the oral cavity, due to its diverse and highly dynamic microbiome, can serve as an initial focus for serious systemic infections, such as ventilator‐associated pneumonia (VAP) [1]. In addition, the literature documents the relationship between diabetes and periodontal disease: clinical and experimental studies indicate a higher risk of developing and progressing periodontitis in people with diabetes [2], and research in a tertiary hospital observed a higher prevalence of periodontitis in diabetic patients compared to non‐diabetics, although there was no statistical difference in oral hygiene practices between the groups [3].
Recent evidence suggests that standardized oral hygiene measures are a low‐cost but highly effective strategy with the potential to reduce the incidence of HAP, shorten hospital stays, and consequently minimize healthcare costs [4].
In this context, the role of the nursing team becomes evident, since these professionals are primarily responsible for implementing hygiene practices, including oral hygiene. However, the effectiveness of these actions depends directly on the technical and scientific expertise of the team, frequent access to continuing education processes, and an understanding of oral hygiene as a critical component of patient safety, rather than merely a matter of comfort [5]. A quasi‐experimental study demonstrated significant knowledge gains among nurses following training at a hospital, with the average score increasing from 6.4±2.2 to 10.4±3.8 points after the educational intervention [6].
Despite the recognized importance of oral hygiene in hospitalized patients, several studies have identified important gaps in nursing professionals' knowledge and adherence to recommended practices. Reported barriers include work overload, the absence of consolidated institutional protocols, shortages of appropriate materials, insufficient academic preparation, lack of time, and low patient adherence [7, 8, 9]. Although greater awareness of the relationship between periodontal and systemic diseases has been reported among female professionals, [10] knowledge gaps remain and may negatively affect clinical practice. Inadequate training may compromise the implementation of evidence‐based recommendations, reinforcing the need for continuing education and closer collaboration with dental professionals [11]. Educational strategies have been shown to improve nursing professionals' knowledge and support the implementation of evidence‐based oral care practices [12]. Therefore, it is essential to implement systematic educational strategies. By offering theoretical updates, correcting inappropriate behavior, and reinforcing scientific foundations, continuing education programs raise the standard of care provided and promote an organizational culture focused on safety and quality of care [4].
Considering the fundamental role of nursing staff in the daily care of hospitalized patients and the lack of specific training on oral hygiene in this context, it is essential to invest in educational strategies targeting these professionals. The absence of institutional protocols, the low integration of dentistry into hospital routines, and the clinical consequences of poor oral hygiene in hospitalized patients reinforce the need for studies that explore effective ways of training multidisciplinary teams. Therefore, research evaluating educational interventions in this area is essential to support evidence‐based practices and promote improvements in the safety and quality of care provided. At the study institution, the need to standardize oral hygiene practices and strengthen the training of nursing professionals was identified, motivating the development of an evidence‐based educational intervention and a Standard Operating Procedure (SOP).
Thus, this study aimed to evaluate the impact of an educational intervention on nursing professionals' knowledge of oral hygiene for hospitalized patients and to examine whether baseline knowledge was associated with sociodemographic and professional characteristics, including age, sex, years since graduation, professional experience, previous instruction, awareness of institutional protocols, and institutional training.
2. Methods
The study adheres to the guidelines outlined in Resolution 466/2012 of the National Health Council, which governs research involving human subjects. The Research Ethics Committee approved the project under No. 6,982,867 and Certificate of Presentation for Ethical Consideration no. 8174.7024.5.000.5319. It is reported in accordance with the recommendations of “The TREND Statement” [13].
2.1. Study Design and Sample
This study is characterized as a single‐group quasi‐experimental study with a convenience sample, in which an educational intervention was implemented and a pre‐ and post‐test were administered using a questionnaire. The questionnaire contained questions with multiple‐choice answers: true, false, or don't know. Quasi‐experimental studies examine cause‐and‐effect relationships between independent and dependent variables without random distribution of participants or groups. Among quasi‐experimental designs, this study employed an interrupted time series design, in which each subject serves as their own control to assess the effect of the educational intervention [14].
2.2. Inclusion and Exclusion Criteria
The inclusion criteria for the study were nurses and nursing technicians from a hospital in southern Brazil, while the exclusion criteria were those who were on holiday or leave at the time of data collection.
The nursing team comprises a total of 680 employees, consisting of 600 nursing technicians and 80 nurses. The sample size was calculated using OpenEpi software, version 3, considering a bilateral significance level of 95% and statistical power of 80%. The parameters used were an Odds Ratio of 6, a risk‐to‐prevalence ratio of 4.8, and a risk‐to‐prevalence difference of 19% [15], using the Kelsey and Fleiss methods with continuity correction. The estimated sample size was 126 participants, to which 20% was added to compensate for potential losses, resulting in a total of 151 participants. However, 13 participants did not complete stages 2 and 3 and were removed from the study, resulting in 13 losses (8.6%), and the final study sample consisted of 138 nursing professionals. Figure 1 represents the flow of the sample considered in the study.
FIGURE 1.
Flowchart of sample selection and study stages.
2.3. Study Location
The hospital is situated in southern Brazil and is a leading philanthropic institution in the region, responsible for performing medium‐ to high‐complexity procedures for a population of approximately 1.6 million people. The hospital serves five Regional Health Coordinators in Rio Grande do Sul and the western region of Santa Catarina and is a reference for highly complex care in Orthopedics and Traumatology, Neurosurgery, Renal Replacement Therapy, Oncology, and Hemodynamics.
2.4. Recruitment of Participants and Data Collection
Participants were recruited at their workplace within the institution chosen for the research. Nurses and nursing technicians were approached and invited to participate after their eligibility was verified.
Data collection was conducted by the principal investigator, with the assistance of another researcher, both of whom were dental surgeons. The two researchers participated in a total of 9 h of prior training focused on standardizing the educational intervention and the application of the questionnaires, with the intention of ensuring uniformity in data collection and conducting activities with the nursing team. To minimize potential bias, the educational intervention followed a standardized protocol and used identical instructional materials in all sessions. The same structured questionnaire was administered before and after the intervention, using standardized instructions for all participants. In addition, questionnaire responses were self‐completed by the participants and statistical analyses were performed after data collection had been completed. Researchers were instructed not to influence participants' responses during questionnaire administration, providing clarification only regarding procedural aspects when necessary.
The collection involved three main stages: Stage 1 ‐ Pre‐test: Application of questionnaires to characterize the sample and assess prior knowledge about oral hygiene in hospitalized patients; Stage 2 ‐ Pre‐test: Educational Intervention; Stage 3 ‐ Post‐test: Reapplication of the questionnaire to assess knowledge about oral hygiene in hospitalized patients.
Stage 1 ‐ Pre‐test (Time 0 – T0)—Application of questionnaires to characterize the sample and prior knowledge of oral hygiene in hospitalized patients
Stage 1 took place during August and September, with 15 visits in both shifts, each visit corresponding to one shift, during working hours in the workplace.
Eligible participants signed the Free and Informed Consent Form (FICF). They then answered the two parts of the questionnaire: the first to characterize the sample (sociodemographic variables) and the second to assess the oral hygiene knowledge of hospitalized patients.
The sociodemographic questions in the first part of the questionnaire included the following variables: profession, gender, age, work shift, prior knowledge of the oral hygiene protocol, prior instruction on oral hygiene, institutional training on the subject, length of service, and length of training.
The second section of the questionnaire assessed knowledge of oral hygiene in hospitalized patients. It consisted of 19 single‐choice questions covering fundamental aspects of oral care in the hospital setting, including the relationship between oral hygiene and the prevention of VAP, specific care for intubated patients, and recommendations based on national guidelines. The questionnaire was adapted from the content‐validated instrument developed by Tonelli [16], which had previously undergone content validation by a panel of experts and pre‐testing. This section included questions (Q) answered using the options “true”, “false”, and “I don't know”. Thirteen statements were correct when marked as “true” (Q1, Q2, Q4, Q6, Q7, Q8, Q9, Q10, Q12, Q13, Q15, Q16, and Q18), whereas six were correct when marked as “false” (Q3, Q5, Q11, Q14, Q17, and Q19).
Q1‐ The oral cavity of hospitalized patients is also contaminated by respiratory pathogens present in the hospital environment.
Q2‐ In addition to comfort, oral hygiene is an important preventive measure against ventilator‐associated pneumonia (VAP).
Q3‐ Tongue hygiene is unnecessary when the patient is intubated.
Q4‐ Lip moisturizing should be performed after oral hygiene.
Q5‐ Oral hygiene is not necessary in patients without teeth.
Q6‐ A highly colonized oral cavity increases biofilm formation (bacterial agglomeration).
Q7‐ Cuff pressure should be checked by the responsible professional before performing oral hygiene.
Q8‐ For oral hygiene, the patient should be positioned with the head elevated between 30° and 45°
Q9‐ Aspiration of the oral cavity is important before and after oral hygiene
Q10‐ Sedatives and other medications expose the patient to oral changes such as hyposalivation and irritation of the oral mucosa
Q11‐ The presence of an orotracheal tube (OTT) makes oral hygiene optional, and may or may not be performed
Q12‐ Oral hygiene is recommended before bathing an intubated patient
Q13‐ The outside of the orotracheal tube (OTT) should be cleaned with a 0.12% chlorhexidine solution
Q14‐ Oral hygiene should be performed with gauze wrapped around the professional's index finger to facilitate cleaning
Q15‐ Oral hygiene with 0.12% chlorhexidine solution should be performed at least twice a day
Q16‐ Cleaning of the oral cavity should always be done from the posterior region of the mouth towards the anterior region
Q17‐ Oral hygiene should only be performed when the patient is bathing
Q18‐ Oral hygiene should be performed with a 0.12% chlorhexidine solution. This is the most effective concentration for use on the oral mucosa and has the lowest rate of reaction, such as changes in tooth coloring
Q19‐ The use of toothbrushes is not recommended in hospitals due to the risk of contamination.
Stage 2 ‐ Educational Intervention
The educational intervention was conducted in October 2024, 30 days after the pre‐test was administered, and each session lasted for 90 min each meeting. As supplementary material, a Standard Operating Protocol (SOP) was developed and made available, based on the Brazilian Guidelines for Mechanical Ventilation (2013) [17] and recommendations from the Brazilian Health Regulatory Agency (ANVISA) [18]. The SOP was posted in strategic locations within the institution, such as nursing stations, to reinforce the intervention and ensure continuous access to the content.
The action consisted of an expository lecture, organized based on the 19 questions of the knowledge assessment instrument, aiming to systematically address the essential content on oral hygiene in hospitalized patients. The content of the intervention was grouped into three thematic blocks: (1) general aspects of oral health in the hospital environment for the prevention of respiratory infections; (2) technical procedures for oral hygiene in the hospital environment; and (3) recommended materials for hygiene. These blocks were constructed based on the information contained in the SOP created for the educational intervention.
The activity was conducted by two previously trained dental surgeons in a total of nine face‐to‐face meetings held in the morning, afternoon, and evening shifts, with an average duration of one hour each. These meetings took place during working hours, and the sessions were held in a classroom at the hospital itself, using audiovisual resources (overhead projector) to facilitate understanding and encourage interaction among participants. At the end of each meeting, time was set aside for questions and answers.
Block 1 – General aspects of oral health in the hospital environment:
The relationship between oral health and the prevention of respiratory infections, especially VAP, was discussed (Q1, Q2, Q6, Q8, Q9, Q10). Oral changes resulting from hospitalization and the use of medication were also addressed, as well as the proper positioning of the patient during hygiene procedures.
Block 2 – Technical procedures and care:
This section covered specific care for intubated patients, such as checking the cuff, cleaning the orotracheal tube, and the appropriate frequency of hygiene (Q3, Q4, Q5, Q7, Q11, Q12, Q13, Q14, Q15, Q16, Q17). Practical examples and clinical images were used to illustrate the recommendations.
Block 3 – Recommended materials for hospital oral hygiene:
The last part of the lecture addressed recommended products for oral hygiene in the hospital environment, such as 0.12% chlorhexidine and the proper use of toothbrushes, clarifying common myths about the risk of contamination (Q18, Q19).
Stage 3 – Post‐test (Time 1 – T1)—Reapplication of the oral hygiene knowledge questionnaire to hospitalized patients
One week after the intervention was completed, the knowledge questionnaires were reapplied to assess the impact of the educational intervention. There were 15 visits, each corresponding to one shift, in both work shifts, during November 2024. The participants were approached, and their names were checked in advance against a list containing all participants, as well as to verify whether they had read the SOP before completing the reapplication of the knowledge questionnaire. After that, there was an opportunity for correction and clarification of doubts.
2.5. Data Analysis
The data were entered into Microsoft Excel 2016 spreadsheets using the double‐entry technique to ensure consistency and avoid errors. The information was then exported to Statistical Package for the Social Sciences (SPSS) software, version 22.0, where statistical analysis was performed.
For categorical variables, absolute and relative frequencies were calculated. The effectiveness of the educational intervention was assessed by comparing pre‐ and post‐test results using the McNemar test, a non‐parametric test suitable for paired categorical data (i.e., before and after in the same sample). For all analyses, a significance level of p < 0.05 was considered.
To investigate the association between prior knowledge and the sociodemographic and professional characteristics of the participants, the score of correct answers in the pre‐test questionnaire was used (score from 0 to 19 points, with 1 point for each correct answer). This score was recategorized into a dichotomous variable: low knowledge (0 to 14 ‐ score below the sample median) and high knowledge (15 to 19 ‐ score equal to or above the median), with a median of 15 and a mean of 14.82 (55.8% of people scored 15 or above). The association between the level of knowledge (high/low) and the independent variables (age, gender, length of training, length of service, previous education, knowledge of institutional protocol, and training received) was analyzed using Pearson's chi‐square test. Both had a significance level of p < 0.05.
3. Results
The 138 participants were predominantly women (82.6%) and nursing technicians (81.2%), with a mean age of 35.46 years (SD = 9.49). The night shift was the most common (42.0%). Regarding career profile, 42.0% had graduated more than 10 years earlier and 37.7% had worked in hospital settings for over 10 years. Most reported receiving instruction on oral hygiene during academic training (80.4%), and 62.3% reported the existence of an institutional protocol; however, fewer than half reported training provided by their institution (40.6%). As for the recency of such training, 59.4% had never been trained; 5.1% had been trained within the past 6 months, 14.5% between 6 and 12 months, and 21.0% more than 12 months earlier. In summary, this depicts an experienced workforce with available protocols but notable gaps in continuing education on oral hygiene.
Table 1 presents a comparison of the nursing team's responses in the pre‐ and post‐tests, before and after the educational intervention, considering the categories ‘Correct’ (True in questions 1, 2, 4, 6 to 10, 12, 13, 15, 16 and 18; and False in questions 3, 5, 11, 14, 17 and 19) and “Incorrect” (the opposite of what was considered correct in the questions mentioned above, adding those who answered “I don't know”). In the statistical analysis, the results from the McNemar test showed statistically significant differences (p < 0.05) for all questions, evidencing a significant improvement in the team's knowledge after the educational intervention in most questions.
TABLE 1.
Comparison of hits and errors in the pre‐test (T0) and post‐test (T1): Before and after the educational intervention in the hospital, 2024 (n = 138).
| Before (T0) | After (T1) | ||||
|---|---|---|---|---|---|
| Questions (Q) |
Correct (n, %) |
Incorrect (n, %) |
Correct (n, %) |
Incorrect (n, %) |
p |
| Q1 | 126 (91.3) | 12 (8.7) | 138 (100.0) | — | * <0.001 |
| Q2 | 128 (92.8) | 10 (7.2) | 138 (100.0) | — | * 0.002 |
| Q3 | 110 (79.7) | 28 (20.3) | 135 (97.8) | 3 (2.2) | * <0.001 |
| Q4 | 118 (85.5) | 20 (14.4) | 136 (98.6) | 2 (1.4) | * <0.001 |
| Q5 | 116 (84.1) | 22 (15.9) | 135 (97.8) | 3 (2.2) | * <0.001 |
| Q6 | 129 (93.5) | 9 (6.5) | 137 (99.3) | 1 (0.7) | * 0.008 |
| Q7 | 92 (66.7) | 46 (33.4) | 134 (97.1) | 4 (2.9) | * <0.001 |
| Q8 | 126 (91.3) | 12 (8.7) | 136 (98.6) | 2 (1.4) | * 0.002 |
| Q9 | 103 (74.6) | 35 (25.3) | 135 (97.8) | 3 (2.1) | * <0.001 |
| Q10 | 121 (87.7) | 17 (12.3) | 138 (100.0) | — | * <0.001 |
| Q11 | 118 (85.5) | 20 (14.5) | 136 (98.7) | 2 (1.4) | * <0.001 |
| Q12 | 60 (43.5) | 78 (56.5) | 118 (85.5) | 20 (14.5) | * <0.001 |
| Q13 | 80 (58.0) | 58 (42.0) | 129 (93.5) | 9 (6.5) | * <0.001 |
| Q14 | 83 (60.1) | 55 (39.9) | 122 (88.4) | 16 (11.6) | * <0.001 |
| Q15 | 118 (85.5) | 20 (14.5) | 136 (98.6) | 2 (1.4) | * <0.001 |
| Q16 | 91 (65.9) | 47 (34.1) | 134 (97.1) | 4 (2.9) | * <0.001 |
| Q17 | 132 (95.7) | 6 (4.3) | 138 (100.0) | — | * 0.031 |
| Q18 | 121 (87.7) | 17 (12.3) | 136 (98.6) | 2 (1.4) | * <0.001 |
| Q19 | 73 (52.9) | 65 (47.1) | 118 (85.5) | 20 (14.5) | * <0.001 |
Note: Non‐parametric test McNemar's test.
< 0.05 ‐ statistically significant differences.
Before the educational intervention, some questions had high error rates, with percentages of correct answers ranging from 43.5%) (Q12) to (95.7%) (Q17). After the intervention, there was a significant increase in the rate of correct answers for all questions, with emphasis on: Q12 (‘Oral hygiene is recommended before bathing intubated patients’), which went from 43.5% to 85.5% correct answers; Q19 (‘The use of a toothbrush is not recommended in the hospital due to the risk of contamination’), which increased from 52.9% to 85.5% correct answers; Q13 (‘The external part of the orotracheal tube should be cleaned with a 0.12% chlorhexidine solution’), whose correct answer rate rose from (58.0%) to (93.5%).
In addition, four questions achieved 100% correct answers in the post‐test, indicating total assimilation of knowledge after the intervention (Q1, Q2, Q10, and Q17).
Table 2 presents the bivariate analysis between sociodemographic and professional variables and the participants' level of knowledge about hospital oral hygiene. The variables were categorized according to the distribution of the sample, and knowledge was classified as “low” or “high” based on the median of the scores obtained in the pre‐test. Most associations were not statistically significant, indicating that, for most of the variables analyzed, the level of knowledge did not differ significantly between the groups. However, a statistically significant association was observed between prior knowledge and the existence of an institutional protocol on oral hygiene (p = 0.001), suggesting that professionals working in institutions with established protocols tend to have greater knowledge on the subject.
TABLE 2.
Bivariate analysis between independent variables and the nursing team's level of knowledge about hospital oral hygiene (n = 138).
| Variables |
Low knowledge (n, %) |
High knowledge (n, %) |
p |
|---|---|---|---|
| Gender | 0.467 | ||
| Female | 52 (85.2) | 62 (80.5) | |
| Male | 9 (14.8) | 15 (19.5) | |
| Profession | 0.513 | ||
| Nurse | 10 (16.4) | 16 (20.8) | |
| Nursing Technician | 51 (83.6) | 61 (79.2) | |
| Age | 0.083 | ||
| 20 to 35 years | 25 (41.0) | 43 (55.8) | |
| 36 to 61 years | 36 (59.0) | 34 (44.2) | |
| Time since graduation | 0.570 | ||
| 1 to 10 years | 37 (60.7) | 43 (55.8) | |
| More than 10 years | 24 (39.3) | 34 (44.2) | |
| Time of professional experience | 0.958 | ||
| 1 to 5 years | 28 (45.9) | 35 (45.5) | |
| More than 5 years | 33 (54.1) | 42 (54.5) | |
| Work shift | 0.538 | ||
| 1 shift (morning, afternoon, or evening) | 53 (86.9) | 65 (84.4) | |
| 2 shifts | 8 (13.1) | 12 (15.6) | |
| Instruction during training | 0.372 | ||
| Yes | 47 (77.0) | 64 (83.1) | |
| No | 14 (23.0) | 13 (16.9) | |
| Institutional protocol | * 0.001 | ||
| Yes | 29 (47.5) | 57 (74.0) | |
| No | 32 (52.5) | 20 (26.0) | |
| Institutional training | 0.336 | ||
| Yes | 22 (36.1) | 34 (44.2) | |
| No | 39 (63.9) | 43 (55.8) |
Note: Pearson's chi‐square test.
< 0.05 ‐ statistically significant differences.
4. Discussion
This quasi‐experimental study aimed to assess nursing staff knowledge about hospital oral hygiene and measure the impact of an educational intervention. The results showed a significant improvement in professionals' knowledge after the educational intervention, with 15 of the 19 questions on the assessment tool achieving more than 95% correct answers in the post‐test. Questions that showed the greatest gains in correct answers included Q12 (43.5% to 85.5%), Q13 (58.0% to 93.5%) and Q19 (52.9% to 85.5%), reflecting the effectiveness of the intervention in correcting specific conceptual gaps.
The improvement in scores highlights the positive impact of continuing education, especially when structured in practical thematic blocks based on institutional protocols. This approach not only increased participants' theoretical knowledge but also promoted understanding of the clinical application of procedures. Before the intervention, accuracy rates varied widely, revealing training deficiencies. After the intervention, the significant increase in correct answers confirms the potential of objective and targeted training to improve the quality of care.
A statistically significant association was found between prior knowledge and the existence of an institutional protocol on oral hygiene, suggesting that organizational environments with established regulations favor the dissemination of knowledge and the adoption of good practices. Similar studies corroborate this finding. A dental care system that included lectures and practical training conducted by dentists resulted in an approximately 60% reduction in the rates of pneumonia associated with stroke [19]. The results presented confirm the effectiveness of the educational intervention, evidenced by the significant improvement in knowledge scores and the substantial reduction in incorrect responses. However, some issues still showed resistance to change, highlighting the need for reinforcement on specific topics. These findings underscore the importance of continuing education in the qualification of nursing staff, promoting safe and evidence‐based practices for the oral hygiene of hospitalized patients.
The effectiveness of oral hygiene‐based care systems has also been supported by organizations such as the European Stroke Organization and the European Society for Swallowing Disorders, which recommend proactive oral health measures for hospitalized patients [20].
In this study, although 80.4% of professionals reported having received some instruction on oral hygiene during their training, only 40.6% received training from the institution where they work. These data reinforce the importance of institutionalizing protocols and systematically offering training. In another study, only 42% of the nurses interviewed had received practical training, while 58% reported having received previous theoretical training [9]. However, another survey reports that only 37.8% of professionals received training in oral health during their undergraduate studies [21].
Although 62.3% of participants reported the existence of institutional protocols, 59.4% had never received specific training. This gap is consistent with findings that show more than half of nurses do not have adequate training to diagnose or manage oral diseases such as gingivitis and caries, and that cooperation with dental specialists is considered essential [11]. Another study also pointed out that nurses' training in oral care is often insufficient, highlighting the need for standardized, evidence‐based protocols [8]. A retrospective cohort study showed that the work of a full‐time dental surgeon contributed to reducing the incidence of pneumonia in patients with acute stroke, reinforcing the importance of integrating dental professionals into the multidisciplinary hospital team for the effective implementation of oral care [22].
The data from this study confirm the positive impact of educational intervention, both in reducing incorrect responses and increasing conceptual understanding. In addition, four questions (Q1, Q2, Q10, and Q17) achieved 100% accuracy after the intervention, indicating a complete understanding of key topics such as oral cavity contamination, VAP prevention, the effects of sedatives, and adequate hygiene frequency. The authors emphasize that interventions led by dentists improve not only the knowledge but also the technical skills of the nursing team, reducing the recurrence of aspiration pneumonia [23].
Another relevant finding was the increase in the percentage of correct answers to the question about cleaning the orotracheal tube with chlorhexidine (from 58% to 93.5%). Similarly, the understanding of the use of toothbrushes in a hospital environment improved significantly. Studies show that mechanical brushing, combined with the use of chlorhexidine, is the most effective practice for preventing oral infections in hospitalized patients, including those in intensive care units [24]. The relationship between oral health and quality of life is widely recognized [25].
The bivariate analysis between sociodemographic characteristics and level of knowledge indicated no statistically significant differences, except the presence of institutional protocols. Authors highlight that the implementation of guidelines and the systematic actions of dentists contribute to strengthening the nursing team and ensuring effective preventive care [26].
Despite the positive results, this study has limitations. The convenience sample conducted in a single hospital limits the generalization of the findings. The predominance of night shift participants may have influenced the representation of experiences. The use of a self‐administered questionnaire also implies a risk of information bias. In addition, the study did not assess objective clinical outcomes, such as healthcare‐associated infection rates or VAP, limiting direct inferences about patient health and safety [27]. It also did not evaluate long‐term knowledge retention or adherence to the implemented SOP. Consequently, although the intervention significantly improved knowledge, its direct impact on patient safety could not be established.
Nevertheless, the data reinforce the relevance of brief educational interventions integrated into hospital routines, with the potential to substantially improve care practices [28, 29]. The quasi‐experimental design is a potential strength of the study, as the participant acts as their own control, minimizing memory bias. Structured institutional protocols and the inclusion of dental surgeons in the multidisciplinary team are promising strategies for advancing patient safety and adhering to international guidelines for hospital oral care [30, 31].
The practical implications of this study are standardizing oral care through a SOP with clear steps and checklists, reducing variability, omissions, and wasted time; thereby improving care (correct execution and consistent records), enhancing staff well‐being (greater self‐efficacy and less rework) and strengthening patient safety (adherence to evidence, possibility of auditing by indicators, and lower infectious risk). Integrated with the onboarding of new professionals and periodic retraining, the intervention tends to be institutionally sustainable and promote a cycle of continuous improvement.
Future multicenter randomized controlled trials with larger samples and long‐term follow‐up are needed to evaluate knowledge retention, adherence to the SOP, and clinical outcomes such as VAP, length of hospital stay, and healthcare costs [32, 33]. The adoption of mixed methods approaches, combining qualitative and quantitative data, may further improve understanding of institutional barriers and professionals' perceptions. From an institutional perspective, asynchronous digital learning platforms complemented by practical training supervised by dental surgeons and periodic audits of protocol adherence may support the sustainability of educational interventions.
5. Conclusion
The results of this quasi‐experimental study showed that the educational intervention aimed at the nursing team was effective in increasing knowledge about hospital oral hygiene. A significant improvement was observed in the participants' performance in the post‐test, with a significant increase in the rates of correct answers on topics essential for the prevention of complications, such as VAP. In addition, a statistically significant association was identified between greater prior knowledge and the presence of institutional protocols, highlighting the relevance of structured organizational environments for the qualification of care practice. These findings reinforce the importance of continuing education and the presence of dental surgeons in multidisciplinary hospital teams, promoting safe, standardized, and evidence‐based oral care.
Author Contributions
Geisiane Garcias Moreira: Writing – review and editing, Writing – original draft, methodology, investigation, formal analysis, conceptualization. William Vinícius de Oliveira Santos: writing – review and editing, supervision, methodology. Lilian Rigo: writing – review and editing, writing – original draft, supervision, methodology, formal analysis.
Funding
The authors declare that they have no funding statement.
Ethics Statement
The study follows the guidelines of Resolution 466/2012 of the National Health Council, which regulates research involving human subjects. The project was approved by the ATITUS Education Research Ethics Committee, under no. 6,982,867 and Certificate of Presentation for Ethical Consideration no. 8174.7024.5.000.5319.
Consent
All participants signed written consent forms after reading a participant information sheet. They were allowed on sent at any time.
Conflicts of Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
The authors express their gratitude to the nurses for their collaboration in this research, and they thank the hospital administrators for their scheduling and logistical support.
Data Availability Statement
The de‐identified dataset generated and analyzed during the current study is not publicly available due to privacy and institutional restrictions. Data may be shared by the corresponding author upon request for research purposes.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The de‐identified dataset generated and analyzed during the current study is not publicly available due to privacy and institutional restrictions. Data may be shared by the corresponding author upon request for research purposes.