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Comment & Response
February 2015

Oral Hygiene With Chlorhexidine in Critically Ill Patients—Reply

Author Affiliations
  • 1Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
  • 2Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 4Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 5Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
JAMA Intern Med. 2015;175(2):316-317. doi:10.1001/jamainternmed.2014.7020

In Reply We wish to thank Sands and colleagues for their letter regarding our meta-analysis on the impact of routine oral care with chlorhexidine gluconate on the incidence of ventilator-associated pneumonia (VAP) and other outcomes. As Sands and colleagues indicated, we found that the impact of chlorhexidine differed in cardiac surgery vs non–cardiac-surgery patients. Among cardiac surgery patients, there was a significant decrease in postoperative pneumonias (mostly non–ventilator associated given that most cardiac surgery patients are ventilated for <24 hours). Among non–cardiac surgery patients, there were no differences between study arms in VAP rates, mean duration of mechanical ventilation, or intensive care unit length of stay. Mortality rates were numerically higher among patients randomized to oral care with chlorhexidine, although this effect was not statistically significant (relative risk [RR], 1.13; 95% CI, 0.99-1.29).