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Effectiveness of Oral Rinse with Chlorhexidine in Preventing Nosocomial Respiratory Tract Infections among Intensive Care Unit Patients

  • Fernando Bellissimo-Rodrigues (a1), Wanessa Teixeira Bellissimo-Rodrigues (a2), Jaciara Machado Viana (a3), Gil Cezar Alkmim Teixeira (a3), Edson Nicolini (a3), Maria Auxiliadora-Martins (a3), Afonso Dinis Costa Passos (a4), Edson Zangiacomi Martinez (a4), Anibal Basile-Filho (a3) and Roberto Martinez (a5)...



To evaluate the effectiveness of the oral application of a 0.12% solution of Chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients.


The study design was a double-blind, randomized, placebo-controlled trial.


The study was performed in an ICU in a tertiary care hospital at a public university.


Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received Chlorhexidine (n = 98) and those who received a placebo (n = 96).


Oral rinses with Chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively.


Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the Chlorhexidine and placebo groups. However, patients in the Chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]).


Oral application of a 0.12% solution of Chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.


Corresponding author

Avenida dos Bandeirantes, 3900, Campus Universitário-Monte Alegre, CEP 14048-900, Ribeirāo Preto, Sāo Paulo, Brazil (


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1.Edwards, JR, Peterson, KD, Andrus, ML, et al.National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290301.
2.Vincent, JL, Bihari, DJ, Suter, PM, et al.The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA 1995;274:639644.
3.Relio, J, Ollendorf, DA, Oster, G, et al.Epidemiology and outcomes of ventilator-associated pneumonia in a large US database. Chest 2002;122:21152121.
4.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887892.
5.Salomao, R, Rosenthal, VD, Grimberg, G, et al.Device-associated infection rates in intensive care units of Brazilian hospitals: findings of the International Nosocomial Infection Control Consortium. Rev Panam Salud Publica 2008;24:195202.
6.Fagon, JY, Chastre, J, Hance, AJ, Montravers, P, Novara, A, Gibert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281288.
7.Heyland, DK, Cook, DJ, Griffith, L, Keenan, SP, Brun-Buisson, C. The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. Am J Respir Crit Care Med 1999;159:12491256.
8.Anderson, DJ, Kirkland, KB, Kaye, KS, et al.Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol 2007;28:767773.
9.Chen, Y-Y, Wang, F-D, Liu, C-Y, Chou, P. Incidence rate and variable cost of nosocomial infections in different types of intensive care units. Infect Control Hosp Epidemiol 2009;30:3946.
10.De Riso, AJ II, Ladowski, JS, Dillon, TA, Justice, JW, Peterson, AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest 1996;109:15561561.
11.Segers, P, Speekenbrink, RGH, Ubbink, DT, Van Ogtrop, ML, De Mol, BA. Prevention of nosocomial infection in cardiac surgery by decontamination of the nasopharynx and oropharynx with Chlorhexidine gluconate: a randomized controlled trial. JAMA 2006;296:24602466.
12.Fourrier, F, Cau-Pottier, E, Boutigny, H, Roussel-Delvallez, M, Jourdain, M, Chopin, C. Effects of dental plaque antiseptic decontamination on bacterial colonization and nosocomial infections in critically ill Patients. intensive Care Med 2000;26:12391247.
13.Fourrier, F, Dubois, D, Pronnier, P, et al.Effect of gingival and dental plaque antiseptic decontamination on nosocomial infections acquired in the intensive care unit: a double-blind placebo-controlled multicenter study. Crit Care Med 2005;33:17281735.
14.Baxter, AD, Allan, J, Bedard, J, et al.Adherence to simple and effective measures reduces the incidence of ventilator-associated pneumonia. Can J Anaesth 2005;52:535541.
15.Koeman, M, Van Der Ven, AJAM, Hak, E, et al.Oral decontamination with Chlorhexidine reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006;173:13481355.
16.Tantipong, H, Morkchareonpong, C, Jaiyindee, S, Thamlikitkul, V. Randomized controlled trial and meta-analysis of oral decontamination with 2% Chlorhexidine solution for the prevention of ventilator-associated pneumonia. Infect Control Hosp Epidemiol 2008;29:131136.
17.Pineda, LA, Saliba, RG, El Solh, AA. Effect of oral decontamination with Chlorhexidine on the incidence of nosocomial pneumonia: a meta-analysis. Crit Care 2006;10:R35. Available at: Accessed January 15, 2007.
18.Chlebicki, MP, Safdar, N. Topical Chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2007;35:595602.
19.Siempos, II, Falagas, ME. Oral decontamination with Chlorhexidine reduces the incidence of nosocomial pneumonia. Crit Care 2007;11:402. Available at: http://ccforum.eom/content/ll/l/402. Accessed December 8, 2008.
20.Kola, A, Gastmeier, P. Efficacy of oral Chlorhexidine in preventing lower respiratory tract infections: meta-analysis of randomized controlled trials. J Hosp Infect 2007;66:207216.
21.Chan, EY, Ruest, A, Meade, MO, Cook, DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334:889. Available at: http://www. Accessed May 8, 2008.
22.Mimoz, O, Dahyot-Fizelier, C. Prevention of ventilator-associated pneumonia: do not forget to disinfect the mouth. Crit Care Med 2007;35:668669.
23.Silvestri, L, Van Saene, HKF, Milanese, M, Zei, E, Blazic, M. Prevention of ventilator-associated pneumonia by use of oral Chlorhexidine. Infect Control Hosp Epidemiol 2009;30:101102.
24.American Thoracic Society; Infectious Diseases Society of America (ATS/IDSA). Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388416.
25.Centers for Disease Control and Prevention (CDC). Guidelines for preventing health-care-associated pneumonia, 2003: recomendations of the CDC and the Healthcare Infection Control Practices Advisory Committee. MMWR Recomm Rep 2004;53(RR-3):136.
26.Coffin, SE, Klompas, M, Classen, D, et al.Strategies to prevent ventilator-associated pneumonia in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1): S41S50.
27.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818829.
28.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care Setting. Am J Infect Control 2008;36:309332.
29.Higgins, CS, Murtough, SM, Williamson, E, et al.Resistance to antibiotics and biocides among non-fermenting Gram-negative bacteria. Clin Microbiol Infect 2001;7:308315.
30.Russell, AD. Antibiotic and biocide resistance in bacteria: introduction. J Appi Microbiol 2002;92(Suppl):1S3S.
31.Berry, AM, Davidson, PM. Beyond comfort: oral hygiene as a critical nursing activity in the intensive care unit. Intensive Crit Care Nurs 2006;22:318328.
32.Kishimoto, H, Urade, M. Mechanical tooth cleaning before Chlorhexidine application. Am J Respir Crit Care Med 2007;175:418.
33.Secretaria de Atençao à Saúde, Departamento de Atençâo Básica, Min-istério da Saúde, Brasil. Projeto SB Brasil 2003: condiçoes de saúde bucal da populaçâo brasileira 2002-2003—resultados principais. Brasilia, Brazil: Ministry of Health; 2004. Available at: Accessed October 8, 2008.
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