Research ArticleResearchInfection ControlQuality Improvement

Economic evaluation of the multicenter HAPPEN cluster trial establishes enhanced inpatient oral care as cost-saving and dominant for preventing non-ventilator hospital pneumonia

The Journal of hospital infection (PubMed)Sep 16, 2026

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Brief summary

A within-trial economic evaluation of the multicenter HAPPEN cluster trial found that an enhanced inpatient oral care protocol was economically dominant, generating cost savings of AUD $152 and gaining 0.02 QALYs per patient by reducing non-ventilator hospital-acquired pneumonia.

What NurseJet pulled from the source

Non-ventilator hospital-acquired pneumonia (NV-HAP) is one of the most common and expensive healthcare-associated infections, yet nurse-delivered oral hygiene is frequently deprioritized on busy medical-surgical wards. Investigators performed a within-trial economic evaluation of the multicenter HAPPEN cluster randomized trial across three Australian acute-care hospitals. Evaluating outcomes from a hospital perspective using an intention-to-treat framework, a cohort-level decision-analytic model integrated intervention rollout and supply costs against NV-HAP acute treatment and saved hospital bed-days (valued in 2025 Australian dollars [AUD]). In a modeled cohort of 1,000 patients, total costs under usual care were AUD $12,148,000 compared to AUD $11,996,000 with the enhanced oral care program. The intervention saved an average of AUD $152 and yielded 0.02 quality-adjusted life-years (QALYs) gained per patient, confirming the protocol as dominant (cheaper and more effective). The incremental net monetary benefit was AUD $642 per patient (95% uncertainty interval: AUD $42 to AUD $1,591). Probabilistic sensitivity analysis demonstrated a 98% probability that enhanced oral care was cost-effective at a threshold of AUD $28,000 per QALY.

Why this matters for nurses

Infection preventionists and medical-surgical nurse leaders often struggle to secure administrative resources and protected nursing time for basic oral hygiene on general wards. Demonstrating that systematic, twice-daily oral care is not only clinically protective against NV-HAP but also cost-saving gives nurses compelling financial and outcome evidence to institutionalize oral care bundles as core quality-improvement priorities.

Bedside takeaway

A within-trial economic evaluation of the multicenter HAPPEN study found nurse-delivered enhanced oral care was dominant and cost-saving, saving AUD $152 and adding 0.02 QALYs per inpatient by preventing NV-HAP.

Key takeaways

Within-trial economic evaluation of the multicenter HAPPEN cluster randomized trial modeled 1,000 inpatient admissions across 3 Australian hospitals.
Nurse-delivered enhanced oral care was economically dominant, reducing total costs while improving health outcomes.
The protocol produced average savings of AUD $152 and 0.02 QALYs gained per patient after accounting for prevented pneumonia bed-days.
Incremental net monetary benefit was AUD $642 per patient, with a 98% probability of cost-effectiveness at an AUD $28,000/QALY threshold.
Findings provide rigorous health-economic justification for nursing leadership to fund oral hygiene supplies and protected shift time for inpatient oral care.

Practice implications

Perform oral cavity assessments upon admission and at least daily; ensure every inpatient has functional toothbrushes, fluoride toothpaste, and chlorhexidine or mouth rinses per protocol; assist dependent and high-risk patients with assisted tooth brushing twice daily.

Limitations & cautions

Economic model derived from three Australian hospitals with specific cost structures (AUD 2025); bed-day valuation and wage costs may vary in other international healthcare systems.
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The Journal of hospital infection (PubMed)

The Journal of hospital infection (PubMed). Economic evaluation of enhanced oral care in reducing the incidence of non-ventilator hospital-acquired pneumonia.

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https://pubmed.ncbi.nlm.nih.gov/42749220/

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This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Internal and emergency medicine (PubMed)Oct 20, 2026Research Article

A multicenter triple-blind randomized controlled trial of 73 emergency department patients found intravenous ibuprofen (800 mg) produced significantly greater pain score reductions at 10 and 30 minutes and shorter ED stays compared with intravenous ketorolac (30 mg).

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Acute low back pain (LBP) accounts for high emergency department utilization, yet clinicians continually seek non-opioid parenteral analgesics that provide rapid, dependable relief without prohibitive adverse profiles. In this multicenter, triple-blind randomized clinical trial conducted across three academic hospital emergency departments, 73 adult patients presenting with acute LBP were randomized to receive either intravenous ibuprofen (800 mg, n=34) or intravenous ketorolac (30 mg, n=39). Analgesic infusions were prepared in quadruplicate blocks by trained head nurses, maintaining blinding for patients, investigators, and biostatisticians. Pain was recorded on a 100-mm Visual Analog Scale (VAS) at baseline, 10 minutes, and 30 minutes post-infusion. Mean VAS pain scores were significantly lower in the ibuprofen arm at 10 minutes (49.6 vs 57.4; p = 0.013) and at 30 minutes (32.2 vs 40.7; p = 0.038). Furthermore, 70.6% of ibuprofen patients achieved mild pain levels by 30 minutes versus 35.9% of ketorolac recipients (p < 0.001). Mean ED length of stay was also significantly shorter in the ibuprofen cohort, while rescue analgesia requirements and drug-related adverse events did not differ between arms.

Key takeaways

Multicenter triple-blind RCT randomized 73 ED patients with acute low back pain to IV ibuprofen 800 mg (n=34) or IV ketorolac 30 mg (n=39).
IV ibuprofen yielded significantly lower VAS pain scores at both 10 minutes (49.6 vs 57.4, p = 0.013) and 30 minutes (32.2 vs 40.7, p = 0.038).
Twice as many patients achieved mild pain intensity at 30 minutes with ibuprofen compared to ketorolac (70.6% vs 35.9%, p < 0.001).
Mean ED length of stay was significantly reduced in the ibuprofen cohort, without any increase in adverse drug events or rescue analgesia.
Findings support IV ibuprofen as an effective, rapid-acting, non-opioid parenteral alternative to ketorolac for acute musculoskeletal back pain in the ED.

Why this matters on shift

Emergency nurses manage acute musculoskeletal back pain daily and frequently administer IV NSAIDs to avoid opioid exposure. Ketorolac has traditionally served as the default parenteral non-opioid, but these triple-blind findings show IV ibuprofen (800 mg) delivers faster and deeper pain reduction within the critical first 30 minutes, doubles the rate of relief down to mild pain, and facilitates earlier discharge without added complications.

Bedside takeaway

In a triple-blind ED RCT of 73 adults with acute low back pain, IV ibuprofen (800 mg) achieved lower VAS pain scores at 10 and 30 minutes and higher mild-pain rates (70.6% vs 35.9%) than IV ketorolac (30 mg).

Nursing implications

Verify renal function, volume status, GI bleeding history, and pregnancy status prior to parenteral NSAID infusion; administer IV ibuprofen over the ordered infusion time and evaluate pain response using a standardized scale at 10 and 30 minutes to determine if rescue analgesia is needed.

Limitations & cautions

Modest total sample size (73 patients) across three university centers; evaluation period concluded at 30 minutes without tracking long-term recurrence or post-discharge outcomes.
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Citations · exact source links

Internal and emergency medicine (PubMed). Intravenous ibuprofen versus ketorolac for acute low back pain in the emergency department: a triple-blind randomized clinical trial.

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Journal of the American College of Cardiology (PubMed)Oct 13, 2026Research Article

The multicenter SUBCUT-HF II randomized trial of 172 hospitalized heart failure patients demonstrated that early discharge using a wearable subcutaneous furosemide minipump achieved 4.0 more days alive and out of hospital at 30 days compared with standard inpatient care.

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Patients hospitalized with decompensated heart failure frequently endure prolonged inpatient admissions solely to finish intravenous loop diuretic titration. In the multicenter, open-label, active-controlled SUBCUT-HF II randomized trial (NCT05419115) conducted across the United Kingdom, 172 patients hospitalized for heart failure who required continued parenteral diuretic therapy were randomized to an early supported discharge strategy (n=92) or usual inpatient care (n=80). The early discharge cohort received a novel pH-neutral formulation of subcutaneous furosemide administered via a wearable, patient-operated minipump, supported by outpatient clinical reviews every 3 days during active infusion, alongside a 2-week follow-up for both arms. The primary endpoint of days alive and out of hospital (DAOH) at 30 days was significantly higher in the early discharge arm (4.0 more days, 95% CI: 2.1–5.8 days; p < 0.001). Mean index hospital stay was shortened by 5.5 days (95% CI: 3.6–7.4 days; p < 0.001). This DAOH benefit was sustained through 60 days (4.2 days, 95% CI: 0.9–7.6 days), despite non-statistically significant higher heart failure readmissions in the early discharge group (14% [n=13] vs 6% [n=5]; OR: 2.45, 95% CI: 0.81–7.43). Serious adverse events occurred in 25% vs 23% of participants, and device issues arose in 3% of placements without serious sequelae.

Key takeaways

Multicenter UK randomized controlled trial (SUBCUT-HF II) evaluated 172 patients hospitalized with heart failure requiring ongoing parenteral diuresis.
Early discharge with a wearable subcutaneous furosemide minipump yielded 4.0 more days alive and out of hospital at 30 days (p < 0.001).
Mean length of index hospital stay decreased by 5.5 days (95% CI: 3.6–7.4 days, p < 0.001) in the subcutaneous minipump cohort.
Clinical benefits persisted at 60 days (4.2 additional DAOH), with comparable serious adverse event rates (25% vs 23%).
Device-related technical issues were observed in only 3% of placements, confirming the mechanical feasibility of outpatient wearable infusion.

Why this matters on shift

Cardiology and telemetry nurses spend extensive time coordinating intravenous diuretic administration, monitoring fluid balances, and planning discharge for heart failure patients who are otherwise clinically stable. Wearable subcutaneous infusion technology enables safe, out-of-hospital decongestion, liberating acute hospital beds and improving patient quality of life, but requires specialized nurse education on pump operation, infusion site care, and vigilant outpatient symptom surveillance.

Bedside takeaway

In the 172-patient SUBCUT-HF II trial, early discharge with a wearable subcutaneous furosemide minipump yielded 4.0 more days alive and out of hospital at 30 days and shortened index hospital stay by 5.5 days.

Nursing implications

Educate heart failure patients on subcutaneous minipump placement, needle insertion site inspection for local erythema or leakage, daily weights, and symptom red flags; coordinate close outpatient follow-up checks every 3 days during active subcutaneous loop diuretic titration.

Limitations & cautions

Open-label trial design; trend toward higher 30-day readmissions (14% vs 6%, OR 2.45) warrants close outpatient monitoring systems; conducted within UK National Health Service infrastructure.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Journal of the American College of Cardiology (PubMed). Early Discharge Strategy Including Subcutaneous Furosemide in Hospitalized Heart Failure.

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Nursing open (PubMed)Oct 1, 2026Research Article

An exploratory randomized clinical trial of 192 cancer patients receiving standardized nurse-led care for totally implantable venous access devices found complication rates were uniformly low across 10 mL saline, 20 mL saline, and heparin lock flushing arms.

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Oncology clinicians continue to debate whether regular heparin locking remains necessary to prevent catheter occlusions in totally implantable venous access devices (TIVADs) or whether normal saline flushes provide adequate patency. In this single-center, prospective, exploratory, single-blind randomized trial conducted in Taiwan (NCT05707936), 192 oncology patients with TIVADs were randomized into three flushing groups: 10 mL normal saline, 20 mL normal saline, or heparin lock (100 units/mL), all delivered within a standardized, protocol-driven, nurse-led catheter care framework. Catheter-related complications were rare across the entire cohort. Only one catheter occlusion occurred (in the 10 mL saline group), while zero occlusions developed in either the 20 mL saline or heparin lock groups. Minor bleeding occurred in three participants, and zero catheter-related bloodstream infections (CRBSIs) or severe adverse events were observed. The exceptionally low complication incidence across all groups precluded definitive statistical non-inferiority conclusions, indicating that standardized nursing competency and strict technique, rather than locking solution alone, drive catheter safety.

Key takeaways

Prospective 3-arm exploratory RCT randomized 192 adult oncology patients with implantable ports to 10 mL saline, 20 mL saline, or heparin lock.
Complication rates were uniformly low under a structured, nurse-led catheter management protocol.
Only one catheter occlusion occurred across all 192 patients (10 mL saline arm), with zero occlusions in the 20 mL saline and heparin groups.
No catheter-related bloodstream infections (CRBSIs) or severe device adverse events occurred in any study arm.
Authors emphasized that standardized nursing care protocols and strict adherence are paramount, while larger trials are needed before omitting heparin.

Why this matters on shift

Oncology and infusion nurses access and de-access implanted venous ports constantly throughout chemotherapy regimens. Omitting heparin locks would simplify nursing workflow, avoid heparin-induced thrombocytopenia risks, and cut medication costs; however, this trial underscores that protocol adherence, pulsatile flushing technique, and positive pressure de-access by trained nurses maintain high patency and low infection rates regardless of flush volume.

Bedside takeaway

In a 192-patient oncology trial of totally implantable ports managed by trained nurses, complications were rare across 10 mL saline, 20 mL saline, and heparin groups (1 occlusion, 0 CRBSIs, 3 minor bleeds).

Nursing implications

Adhere strictly to standardized, aseptic catheter access protocols; use vigorous pulsatile flushing and positive-pressure clamp sequences; do not abandon institutional heparin locking protocols until supported by definitive phase 3 non-inferiority data.

Limitations & cautions

Single-center exploratory design; low event rates precluded statistically powered comparative non-inferiority inferences between saline volumes and heparin locks.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Nursing open (PubMed). Flushing Strategies for Totally Implantable Venous Access Devices in Nurse-Led Cancer Care: Exploratory Randomized Clinical Trial.

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Key takeaways

Practice implications

Limitations & cautions

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More updates for this clinical area

Triple-blind randomized trial of 73 ED patients finds intravenous ibuprofen achieves superior acute pain relief compared with ketorolac for acute low back pain

Multicenter trial of 172 hospitalized heart failure patients finds wearable subcutaneous furosemide minipump strategy adds 4.0 days alive and out of hospital at 30 days

Exploratory randomized trial of 192 cancer patients demonstrates uniformly low catheter complications under standardized nurse-led port flushing protocols