title: Prevention of ventilator-associated pneumonia with oral antiseptics: a systematic review and meta-analysis.
abstract: BACKGROUND
  We did a systematic review and random effects meta-analysis of randomised trials to assess the effect of oral care with chlorhexidine or povidone-iodine on the prevalence of ventilator-associated pneumonia versus oral care without these antiseptics in adults.
  
  
  METHODS
  Studies were identified through PubMed, CINAHL, Web of Science, CENTRAL, and complementary manual searches. Eligible studies were randomised trials of mechanically ventilated adult patients receiving oral care with chlorhexidine or povidone-iodine. Relative risks (RR) and 95% CIs were calculated with the Mantel-Haenszel model and heterogeneity was assessed with the I(2) test.
  
  
  RESULTS
  14 studies were included (2481 patients), 12 investigating the effect of chlorhexidine (2341 patients) and two of povidone-iodine (140 patients). Overall, antiseptic use resulted in a significant risk reduction of ventilator-associated pneumonia (RR 0.67; 95% CI 0.50-0.88; p=0.004). Chlorhexidine application was shown to be effective (RR 0.72; 95% CI 0.55-0.94; p=0.02), whereas the effect resulting from povidone-iodine remains unclear (RR 0.39; 95% CI 0.11-1.36; p=0.14). Heterogeneity was moderate (I(2)=29%; p=0.16) for the trials using chlorhexidine and high (I(2)=67%; p=0.08) for those assessing povidone-iodine use. Favourable effects were more pronounced in subgroup analyses for 2% chlorhexidine (RR 0.53, 95% CI 0.31-0.91), and in cardiosurgical studies (RR 0.41, 95% CI 0.17-0.98).
  
  
  CONCLUSIONS
  This analysis showed a beneficial effect of oral antiseptic use in prevention of ventilator-associated pneumonia. Clinicians should take these findings into account when providing oral care to intubated patients.
  
  
  BACKGROUND
  None.
authors.affiliation: Faculty of Healthcare Vesalius, University College Ghent, Ghent, Belgium.
authors.forename: Sonia O
authors.initials: SO
authors.lastname: Labeau
authors.forename: Katrien
authors.initials: K
authors.lastname: Van de Vyver
authors.forename: Nele
authors.initials: N
authors.lastname: Brusselaers
authors.forename: Dirk
authors.initials: D
authors.lastname: Vogelaers
authors.forename: Stijn I
authors.initials: SI
authors.lastname: Blot
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage*; D016001:Confidence Intervals; D006801:Humans; D009067:Mouthwashes / Q000008:administration & dosage*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control*; D011206:Povidone-Iodine / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D011206:Povidone-Iodine; D002710:Chlorhexidine