Evidence-Based Answers

Oral care with chlorhexidine reduces risk of VAP in intubated patients

Clinical Question:
Does oral care with chlorhexidine or povidone-iodine decrease the risk of ventilator-associated pneumonia in intubated patients?

Bottom Line:
In intubated patients, oral care with antiseptics reduces the risk of ventilator-associated pneumonia (VAP) as compared with oral care without antiseptics. Current evidence best supports the use of chlorhexidine in this population. (LOE = 1a-)

Reference:
Labeau SO, Van de Vyver K, Brusselaers N, Vogelaers D, Blot SI. Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis. Lancet Infect Dis 2011;11(11):845-854.  [PMID:21798809]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Self-funded or unfunded

Setting:
Inpatient (ICU only)

Synopsis:
These investigators searched multiple databases, conference abstracts, and bibliographies of relevant articles for randomized controlled trials that evaluated the use of oral care with chlorhexidine or povidone-iodine to prevent VAP in mechanically ventilated patients. The authors independently selected the studies for inclusion, extracted data, and assessed the quality of the research. Of the 14 included studies (N = 2481), the majority took place in mixed intensive-care units. Twelve of the studies investigated the effect of chlorhexidine and 2 investigated povidone-iodine. Specific interventions in the different studies varied considerably, ranging from the use of oral swab with chlorhexidine liquid to the application of chlorhexidine paste. A meta-analysis of all 14 trials showed that the use of oral chlorhexidine or povidone-iodine during oral care significantly reduced the incidence of VAP (relative risk [RR] = 0.67; 95% CI, 0.50-0.88; P = .004). After subgroup analyses, the risk reduction remained significant in the chlorhexidine studies (RR = 0.72; 0.55-0.94; P = .02), but not in the povidone-iodine studies.