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Chlorhexidine for Oral Care: A Review of Clinical Effectiveness and Guidelines

Last updated: January 25, 2019
Project Number: RC1064-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report


  1. What is the clinical effectiveness of Chlorhexidine for oral care in hospitalized adults?
  2. What are the evidence-based guidelines regarding the use of Chlorhexidine for oral care in hospitalized adults?

Key Message

Chlorhexidine oral care was effective for the prevention of nosocomial pneumonia (NP), ventilator-associated pneumonia (VAP) and bloodstream infection among adult populations in cardiothoracic intensive care units (ICUs), but evidence is unclear in the medical or non-cardiac surgery ICUs. Chlorhexidine was associated with a high risk of mortality in non-cardiac surgery patients. The effectiveness of chlorhexidine of different strengths, preparation or frequency of use for the prevention of NP and VAP was inconclusive. There was no evidence for an association between chlorhexidine and the reductions in duration of ventilation, duration of ICU stay, antibiotic exposures or oral health indices. Oral mucosal lesions were common adverse events associated with chlorhexidine. Current guidelines provided no formal recommendations due to the uncertainty in the risk-benefit balance of chlorhexidine oral care.