Chlorhexidine within a standardized oral-care bundle for the prevention of ventilator-associated pneumonia: a pragmatic cluster-randomized crossover trial in six medical intensive care units.
S Anushapreethi, Pritam Chhotray, Samir Samal et al.
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In 30 seconds
This pragmatic cluster-randomized crossover trial in six adult medical ICUs at one Indian tertiary-care hospital compared a standardized oral-care bundle with the same bundle plus 0.12% chlorhexidine (CHX) in adults ventilated for at least 48 hours. Among 1,035 patients, adding CHX did not significantly change ventilator-associated pneumonia incidence: 16.9 versus 18.8 per 1,000 ventilator-days without and with CHX, respectively (adjusted incidence rate ratio 1.08, 95% CI 0.84-1.38; p = 0.56). Twenty-eight-day mortality also did not differ significantly; ICU stay was modestly longer in the CHX arm.
Key findings
- VAP incidence was 16.9 versus 18.8 per 1,000 ventilator-days (No CHX vs. CHX); adjusted incidence rate ratio 1.08 (95% CI 0.84-1.38; p = 0.56).
- Twenty-eight-day mortality was 28.7% versus 26.4% (no CHX vs. CHX; adjusted OR 0.87, 95% CI 0.65-1.15; p = 0.33).
- ICU length of stay was longer with CHX by an adjusted mean difference of + 0.89 days (95% CI + 0.19 to + 1.58; p = 0.013).
- BOAS and CPOT scores did not differ between groups.
Why it matters
The trial tests whether CHX adds benefit when oral care is already standardized, rather than comparing oral care with no bundle. Its findings provide no evidence of reduced VAP or mortality from adding CHX in this mixed medical ICU population, while the longer ICU stay warrants cautious interpretation. This distinction is relevant when evaluating the components of established prevention bundles.
What to keep in mind
The trial was conducted in six medical ICUs at a single tertiary-care hospital, limiting generalizability. The reported outcomes do not establish why ICU stay was longer in the CHX arm.