Observational studyIntensive care medicine2018
Effects of chlorhexidine gluconate oral care on hospital mortality: a hospital-wide, observational cohort study.
Observational study in Intensive care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 50 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy of Pre-intubation Chlorhexidine Oral Care on Health Outcomes
The Effect of Oral Care Frequency on Oral Mucosa Membrane Integrity in Patients With Mechanical Ventilation Support
Who cites it
50 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Development of oral dysbiosis following use of antimicrobial mouthwashes: a systematic review.Odontology · 2026Pooled it
- Effect of perioperative oral care on postoperative pneumonia in thoracic surgery patients: a systematic review and meta-analysis.Scientific reports · 2025Pooled it
- Association Between Daily Toothbrushing and Hospital-Acquired Pneumonia: A Systematic Review and Meta-Analysis.JAMA internal medicine · 2024Pooled it
- Pooled it
- Oral mucositis as a pathway for fatal outcome among critically ill patients exposed to chlorhexidine: post hoc analysis of a randomized clinical trial.Critical care (London, England) · 2019Trial
- Can probiotics be an alternative to chlorhexidine for oral care in the mechanically ventilated patient? A multicentre, prospective, randomised controlled open trial.Critical care (London, England) · 2018Trial
- Beyond the Lungs: ICU Oral Care and Gut Resilience-A Hypothesis-Generating Narrative Review.Microorganisms · 2026Review
- Prevention of ventilator-associated pneumonia: intensive care nurses' perspectives and solution-oriented recommendations-a qualitative study.BMC nursing · 2026Article
- Effectiveness of toothbrushing as a replacement for chlorhexidine in oral care, combined with head elevation for the prevention of ventilator-associated pneumonia in intensive care units: interrupted time-series analysis.Critical care (London, England) · 2026Article
- A potential bundle for preventing ventilator-associated pneumonia in the emergency department: A narrative review.The Journal of international medical research · 2026Article
- Oral Hygiene Interventions and Pneumonia Prevention in Critical Care: An Integrative Review of Evidence and Practice.International journal of dentistry · 2026Review
- Effect of antimicrobial oral rinse use on prognostic scores in critically ill patients.Brazilian oral research · 2026Article
- Oropharyngeal Interventions in Intubated Patients for Preventing Ventilator Associated Pneumonia: A Systematic Review and Multi-Variate Network Meta-Analysis Evaluating Pharmacological Agents.Journal of clinical medicine · 2025Review
- Single-use versus multiple-use endotracheal suction catheters flushed with chlorhexidine in mechanically ventilated ICU patients: A study protocol of a feasibility randomized controlled trial with an embedded qualitative study.Nursing in critical care · 2025Article
- Development of Solid Nanosystem for Delivery of Chlorhexidine with Increased Antimicrobial Activity and Decreased Cytotoxicity: Characterization and In Vitro and In Ovo Toxicological Screening.Molecules (Basel, Switzerland) · 2025Article
- The comparative effect of propolis and chlorhexidine mouthwash on oral nitrite-producing bacteria and blood pressure regulation.Journal of oral microbiology · 2025Article
- Strategies for the prevention of periodontal disease and its impact on general health: Latin America and the Caribbean Consensus 2024.Brazilian oral research · 2024Review
- Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic.Respiratory care · 2024Review
- Improving Outcomes in Nosocomial Pneumonia: Recent Evidence and More Challenges.Pathogens (Basel, Switzerland) · 2024Review
- The chemical biology of dinitrogen trioxide.Redox biochemistry and chemistry · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeChlorhexidine oral care is widely used in critically and non-critically ill hospitalized patients to maintain oral health. We investigated the effect of chlorhexidine oral care on mortality in a general hospitalized population.
methodsIn this single-center, retrospective, hospital-wide, observational cohort study we included adult hospitalized patients (2012-2014). Mortality associated with chlorhexidine oral care was assessed by logistic regression analysis. A threshold cumulative dose of 300 mg served as a dichotomic proxy for chlorhexidine exposure. We adjusted for demographics, diagnostic category, and risk of mortality expressed in four categories (minor, moderate, major, and extreme).
resultsThe study cohort included 82,274 patients of which 11,133 (14%) received chlorhexidine oral care. Low-level exposure to chlorhexidine oral care (≤ 300 mg) was associated with increased risk of death [odds ratio (OR) 2.61; 95% confidence interval (CI) 2.32-2.92]. This association was stronger among patients with a lower risk of death: OR 5.50 (95% CI 4.51-6.71) with minor/moderate risk, OR 2.33 (95% CI 1.96-2.78) with a major risk, and a not significant OR 1.13 (95% CI 0.90-1.41) with an extreme risk of mortality. Similar observations were made for high-level exposure (> 300 mg). No harmful effect was observed in ventilated and non-ventilated ICU patients. Increased risk of death was observed in patients who did not receive mechanical ventilation and were not admitted to ICUs. The adjusted number of patients needed to be exposed to result in one additional fatality case was 47.1 (95% CI 45.2-49.1).
conclusionsThese data argue against the indiscriminate widespread use of chlorhexidine oral care in hospitalized patients, in the absence of proven benefit in specific populations.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.