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This article is part of the supplement: International Conference on Prevention & Infection Control (ICPIC 2011)

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Evidence on the best way to perform oral hygiene with chlorhexidine in critically ill patients: systematic review and meta-analysis

JR Gnatta1, IRS Cabral de Menezes2 and RA Lacerda1*

  • * Corresponding author: RA Lacerda

Author Affiliations

1 Nursing School, University of Sao Paulo, Sao Paulo, Brazil

2 Comission Control Hospital Infection , University Hospital HU-USP, Sao Paulo, Brazil

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BMC Proceedings 2011, 5(Suppl 6):P72  doi:10.1186/1753-6561-5-S6-P72

The electronic version of this article is the complete one and can be found online at:

Published:29 June 2011

© 2011 Gnatta et al; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction / objectives

Although the scientific literature has demonstrated the relevance of oral hygiene with chlorhexidine (CHX) in the prevention of pneumonia, there is wide variation in the product, concentration, frequency, duration and technique application.


Systematic review and meta-analysis of articles in English, Spanish or Portuguese. Bases: Cochrane, EMBASE, Lilacs, PubMed/Medline, Ovid. Search: October to November 2010 using descriptors indexed. Question: are there evidence about the best way to perform oral hygiene with chlorhexidinefor prevention of respiratory infection in critically ill patients on mechanical ventilation?


10 primary studies were grouped in 4 groups (G1-4) based in criteria of concentration of CHX. G1 (10 primary studies with different concentrations of CHX) studies were homogeneous (Cochrane Q het p=0.35) and the common RR was significative (p<0.001 and CI=95%); G2 (5 primary studies CHX 0.12%) showed homogeneity (Cochrane Q het p=0.67) and the use of CHX represented protection (p<0.05); The G3 (3 primary studies CHX 0.2%) there was heterogeneity between studies (p=0.037) and CHX not represent a protective factor (p>0.05), G4 (2 primary studies CHX 2%) homogeneous studies (Cochran Q het p=0.62) and use of CHX was significant (p=0.021<0.05).


If seems no doubt about the protective effect of oral hygiene with CHX in preventing pneumonia in critically ill patients, there is no evidence for adoption of protocols to guide the CHX concentration, as well as duration, frequency and application technique.

Disclosure of interest

None declared.