Fixing Bedside Oral Care: A Systems Approach for Hospitals and Long-Term Care

Poor Oral Care Drives Preventable Infections

Poor oral care in hospitals and long-term care settings remains a persistent, under-recognised driver of patient harm. In intensive care units and other acute wards, inadequate oral hygiene contributes to hospital-acquired and ventilator-associated pneumonia, increases antibiotic use, prolongs stays, and raises costs. Outside the ICU, nursing homes, hospice units, and senior-care centres face the same problem: staff are busy, protocols are complex, and consistent delivery is hard to sustain. The result is a gap between what evidence recommends and what actually happens at the bedside. 

Why Oral Care Protocols Fail at the Bedside

Two practical realities explain why this gap persists. First, many oral-care regimens are fragmented: a single cleaning can require a dozen-plus distinct tools and up to twenty minutes, creating friction and low compliance among nursing teams. Second, variability in dosing and technique – from how rinses are prepared to inconsistent suctioning – makes it difficult to translate good intentions into reproducible patient benefit. In short, the problem is not a lack of awareness; it is poor design for the realities of frontline care. 

A Systems-Based Oral Care Solution

A systems response, designing for the bedside rather than assembling parts, changes that equation. Instead of separate toothbrushes, swabs, rinse bottles, Yankauer suction, and multiple disposables, an integrated kit that combines measured-dose chemistry, an ergonomic brush, a tongue scraper, and active suction reduces task fragmentation. When dosing, brushing, and suction occur as a single, coordinated action, the protocol can be simplified from many discrete steps to a handful of intuitive ones. That simplicity directly improves nurse compliance, shortens procedure time, and reduces variability in how care is delivered. The desired effect is twofold: better process adherence and a cleaner oral environment that lowers the risk of infection. 

Design Features That Improve Compliance 

Design details matter. Measured, prefilled rinses avoid dosing errors and the workflow burden of mixing or pouring solutions; an integrated suction path removes secretions in real time, reducing fluid pooling and aspiration risk; and a single-headed device with a tongue scraper preserves a nurse’s hand-motion continuity so the task fits into a 1–2 minute window rather than a 20-minute chore. These changes are modest from an engineering standpoint but profound in clinical effect because they remove the key barriers to consistent, repeatable care. 

Scaling Oral Care Programs in Healthcare

Adoption requires convincing evidence and operational readiness. Single-site pilots and independent lab validation can show usability and hygiene benefits; powered, multi-site studies are needed to demonstrate reproducible reductions in infection rates. Equally important is supply-chain and service design: products must be reliably available, simple to stock, and supported by training and documentation so that hospitals and care homes can maintain programs at scale. Linking clinical outcomes to hospital economics – for example, converting prevented pneumonia cases into avoided costs – creates an incentive for systems to invest in sustained adoption rather than episodic trials. 

Improving Patient Safety Through Better Oral Care

Where this approach shows promise is in aligning clinician workflow with measurable outcomes. When a device is engineered to fit the rhythm of nursing shifts and to remove hidden steps, compliance improves. When compliance improves, so does the consistency of exposure to the clinical intervention, and with consistency comes the possibility of measurable reductions in morbidity. For environments such as ICUs, nursing homes, and hospice care, where staffing pressure and high acuity make complex protocols impractical, a pragmatic, device-led systems solution offers a route to safer, simpler care. 

References 

• Toothsure pitch deck (Dec 2025) — clinical problem, product features, and adoption model. 
• Masri, et.al.; “Improving Outcomes in Nosocomial Pneumonia: Recent Evidence and Mor Challenges, Pathogens 2024, 13, 295. https://dci.org/10.3390/pathogens13060495 

• Ehrenzeller and Michael Klompas, “Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia; A Systematic Review and Meta Analysis”; Jama Internal Med,2024;184(2):131-142 

• https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2812938 

• Barbara J.Quinn, “Maximizing Value” The Hidden Benefits of Preventing Hospital-Acquired Pneumonia Through Oral Hygiene, Infection Control Today, 2024;https://www.infectioncontroltoday.com/view/maximizing-value-hidden-benefits-preventing-hospital-acquired-pneumonia-through-oral-hygiene 

• Foucrier, et.al. “Antimicrobial Stewardship for Ventillator Associated Pneumonia in Intensive Care (the ASPIC trial): study protocol for a randomised controlled trial” BMJ open, 2023; 13:e065293.doi:10.1136 

• https://bmjopen.bmj.com/content/bmjopen/13/2/e065293.full.pdf 

• Klompas, et.al. “Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia  

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