Does Oral Chlorhexidine Mouth Care Prior to Intubation Impact Ventilator-Associated Pneumonia? A Systematic Review

Background: Chlorhexidine gluconate (CHG) is a broad-spectrum antiseptic agent that has become widely used for mouth care in intubated patients. Many studies have found it to be effective in the prevention of ventilator-associated pneumonia (VAP) when used after intubation; however, there is very limited research exploring the proper time to initiate CHG. Purpose: The purpose of this systematic review was to determine if the use of oral care with CHG prior to intubation impacts the incidence of VAP. Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was used to guide the selection process of articles and the Critical Appraisal Skills Programme (CASP) was used to critically appraise the randomized control trials (RCTs) selected for this systematic review. Four randomized RCTs met inclusion criteria. Results: Three of the four RCTs which met inclusion criteria, Houston et al. (2002), DeRiso et al. (1996), and Lin et al. (2015), showed an improvement in VAP rates with the use of preintubation CHG in cardiac surgery patients. Only one RCT, the Munro et al. (2015) study, showed no benefit; this was the only study that included non-cardiac surgery patients. Conclusion: Based on the results of this systematic review, it can only be recommended that cardiac surgery patients receive CHG prior to or after intubation; however, more research needs to be done to determine the most effective dosing, frequency, and CHG application procedure. In addition, further study exploring the safety of administering CHG prior to intubation in noncardiac surgery patients is needed