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
Primary result · VAP incidence density (Clinical Pulmonary Infection Score (CPIS) > 6) per 1,000 ventilator-daysResult — go to the resultAdjusted Poisson incidence rate ratio 1.08 95% CI 0.84–1.38Authors' conclusion
In this trial, adding 0.12% chlorhexidine to a standardized oral-care bundle did not reduce VAP incidence density or 28-day mortality and was associated with a modest increase in ICU length of stay. Routine CHX use provided no clear incremental benefit in a mixed medical ICU population.
Study context
- Population
- Consecutive adults ventilated for ≥ 48 h in six adult medical ICUs of a single tertiary-care academic hospital in Bhubaneswar, Indiapatients, accrued 10,024 ventilator-days (5,918 vs. 4,106)
- Participants
- 1,035 adults
- Comparison
- Adding 0.12% chlorhexidine (CHX) to standardized oral-care bundle vs the bundle without chlorhexidine
- No CHXn = 637reference
- CHXn = 398
- Primary endpoint
- Ventilator-associated pneumonia (VAP) incidence density (Clinical Pulmonary Infection Score (CPIS) > 6) per 1,000 ventilator-days
Methodological detailssix adult medical ICUs of a single tertiary-care academic hospital, 1-month wash-in and re-training interval, population-averaged Poisson generalized estimating equation (GEE)
- Six adult medical ICUs of a single tertiary-care academic hospital
- 1-month wash-in and re-training interval
- Population-averaged Poisson generalized estimating equation (GEE)
Primary result
As reported in the abstract
Adjusted Poisson incidence rate ratio
1.08
95% CI 0.84–1.38
P = 0.56
Events by treatment group
CHXvs No CHX
adjusted Poisson incidence rate ratio 1.08 (95% CI 0.84–1.38); P = 0.56
Secondary outcomes
| Outcome | No CHX | CHX | Adjusted OR (95% CI) | P value | |
|---|---|---|---|---|---|
| 28-day mortality | 28.7% | 26.4% | 0.87 (0.65–1.15) | P = 0.33 | |
| 0.512Adjusted odds ratio (log scale) |
| Outcome | Adjusted mean difference (days) (95% CI) | P value |
|---|---|---|
| ICU length of stayLonger in the CHX arm | + 0.89 (+ 0.19 to + 1.58) | P = 0.013 |
Baseline balance
- Groups were well balanced at baseline (mean age ≈ 55 years; APACHE II ≈ 19.6; SOFA ≈ 13.4)
Beck Oral Assessment Scale (BOAS) and CPOT scores
- Did not differ
Original publication
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. Crit Care. Published 29 October 2026. doi:10.
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