title: Effectiveness of oral rinse with chlorhexidine in preventing nosocomial respiratory tract infections among intensive care unit patients.
abstract: OBJECTIVE
  To evaluate the effectiveness of the oral application of a 0.12% solution of chlorhexidine for prevention of respiratory tract infections among intensive care unit (ICU) patients.
  
  
  METHODS
  The study design was a double-blind, randomized, placebo-controlled trial.
  
  
  METHODS
  The study was performed in an ICU in a tertiary care hospital at a public university. PATIENTS. Study participants comprised 194 patients admitted to the ICU with a prospective length of stay greater than 48 hours, randomized into 2 groups: those who received chlorhexidine (n = 98) and those who received a placebo (n = 96).
  
  
  METHODS
  Oral rinses with chlorhexidine or a placebo were performed 3 times a day throughout the duration of the patient's stay in the ICU. Clinical data were collected prospectively.
  
  
  RESULTS
  Both groups displayed similar baseline clinical features. The overall incidence of respiratory tract infections (RR, 1.0 [95% confidence interval [CI], 0.63-1.60]) and the rates of ventilator-associated pneumonia per 1,000 ventilator-days were similar in both experimental and control groups (22.6 vs 22.3; P = .95). Respiratory tract infection-free survival time (7.8 vs 6.9 days; P = .61), duration of mechanical ventilation (11.1 vs 11.0 days; P = .61), and length of stay (9.7 vs 10.4 days; P = .67) did not differ between the chlorhexidine and placebo groups. However, patients in the chlorhexidine group exhibited a larger interval between ICU admission and onset of the first respiratory tract infection (11.3 vs 7.6 days; P = .05). The chances of surviving the ICU stay were similar (RR, 1.08 [95% CI, 0.72-1.63]).
  
  
  CONCLUSIONS
  Oral application of a 0.12% solution of chlorhexidine does not prevent respiratory tract infections among ICU patients, although it may retard their onset.
authors.affiliation: Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Brazil. fbellissimo@ig.com.br
authors.forename: Fernando
authors.initials: F
authors.lastname: Bellissimo-Rodrigues
authors.forename: Wanessa Teixeira
authors.initials: WT
authors.lastname: Bellissimo-Rodrigues
authors.forename: Jaciara Machado
authors.initials: JM
authors.lastname: Viana
authors.forename: Gil Cezar Alkmim
authors.initials: GC
authors.lastname: Teixeira
authors.forename: Edson
authors.initials: E
authors.lastname: Nicolini
authors.forename: Maria
authors.initials: M
authors.lastname: Auxiliadora-Martins
authors.forename: Afonso Dinis Costa
authors.initials: AD
authors.lastname: Passos
authors.forename: Edson Zangiacomi
authors.initials: EZ
authors.lastname: Martinez
authors.forename: Anibal
authors.initials: A
authors.lastname: Basile-Filho
authors.forename: Roberto
authors.initials: R
authors.lastname: Martinez
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009960:Oropharynx / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine