Chlorhexidine Gluconate

Indications

Decontamination Agents
- Chlorhexidine Gluconate: used for body surface decontamination
- Mupirocin (Bactroban) (see Mupirocin): used for eradication of nasal Staphylococcus Aureus carriage (see Staphylococcus Aureus)
Clinical Efficacy in the Prevention of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection in the ICU
- DECIDE Trial of Universal vs Targeted Decolonization to Prevent Infections in the ICU (NEJM, 2013) [MEDLINE]
  - Universal Decolonization (Chlorhexidine) was Superior to Targeted Decolonization of MRSA Carriers (Chrlorhexidine + Nasal Mupirocin) and MRSA Screening and Isolation Strategies in Preventing the Rate of MRSA Isolates and Bloodstream Infection from Any Pathogen: targeted decolonization was intermediate in effectiveness, while screening and isolation did not decrease the rate of any infections
  - Universal Decolonization Prevented 1 Bloodstream Infection Per Each 54 Patients
- Trial of Body Surface Decolonization on Bacteriuria and Candiduria in the ICU (Lancet Infect Dis, 2016) [MEDLINE]
  - Universal Decolonization (Chlorhexidine) and Short-Course Nasal Mupirocin Significantly Decreased Candiduria and Any Bacteriuria, But Not for Women

Clinical Efficacy
- Non-Randomized Trial of Oral Care in Mechanically Ventilated Patients for Prevention of Ventilator-Associated Pneumonia (Intensive, Care Med, 2006) [MEDLINE]
  - Oral Care Decreased Ventilator-Associated Pneumonia Rates
- Meta-Analysis of 7 Randomized Trials Studying Topical Chlorhexidine Applied to the Oropharynx (Crit Care Med, 2007) [MEDLINE]
  - Topical Chlorhexidine Decreased VAP Rates, Especially in Cardiac Surgery Patients
- Systematic Review and Meta-Analysis of Oral Decontamination in Mechanically Ventilated Patients for Prevention of Ventilator-Associated Pneumonia (BMJ, 2007) [MEDLINE]
  - Oral Antiseptic Decontamination and Oral Topical Antibiotic Decontamination of Mechanically-Ventilated Patients Decreased Ventilator-Associated Pneumonia Rates
  - However, Neither Oral Antiseptic Decontamination Nor Oral Topical Antibiotic Decontamination Decreased Mortality Rate or Duration of Mechanical Ventilation
Recommendations (2012 Surviving Sepsis Guidelines; Crit Care Med, 2013) [MEDLINE]
- Selective Oral and Digestive Decontamination Should Be Introduced and Investigated as a Means to Decrease the Risk of Ventilator-Associated Pneumonia (Grade 2B Recommendation)
- Oral Chlorhexidine Gluconate Decontamination Should Be Used as a Means to Decrease the Risk of Ventilator-Associated Pneumonia in ICU Patients with Sepsis (Grade 2B Recommendation)

Oral care reduces incidence of ventilator-associated pneumonia in ICU populations. Intensive Care Med 2006;32:230-236 [MEDLINE]
Topical chlorhexidine for prevention of ventilator-associated pneumonia: a meta-analysis. Crit Care Med 2007;35:595-602 [MEDLINE]
Oral decontamination for prevention of pneumonia in mechanically ventilated adults: systematic review and meta-analysis. BMJ 2007;334:889 [MEDLINE]
Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013 Feb;41(2):580-637. doi: 10.1097/CCM.0b013e31827e83af [MEDLINE]
DECIDE Trial. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368:2255–2265 [MEDLINE]
Screening inpatients for MRSA—case closed. N Engl J Med. 2013;368:2314–2315 [MEDLINE]
Effect of body surface decolonisation on bacteriuria and candiduria in intensive care units: an analysis of a cluster-randomised trial. Lancet Infect Dis. 2016 Jan;16(1):70-9. doi: 10.1016/S1473-3099(15)00238-8. Epub 2015 Nov 27 [MEDLINE]