Table 2.
Summary of systemic reviews findings on the effect of chlorhexidine used in ICUs
| Study | Intervention/comparisons | Outcomes | Relative effect | Number of participants | Grade |
|---|---|---|---|---|---|
|
Zhao et al. [46] China |
CHX (mouth rinse or gel) versus placebo/usual care | VAP |
CHX reduced VAP: RR 0.67 (95% CI 0.47–0.97) |
1206 (13 studies) | ⨁⨁⨁◯ Moderate |
| Mortality |
No difference RR 1.03 (95% CI 0.80 to1.33) |
944 (9 studies) | ⨁⨁⨁◯ Moderate | ||
| ICU stay |
No difference 0.89 (95%CI-3.59–1.82) |
627 (5 studies) | ⨁⨁◯◯ Low | ||
|
Silvestri et al. [69] Italy |
CHX (0.12–0.2% solution or gel) versus placebo, usual care | Mortality |
No difference OR: 0.69 (95% CI 0.31–1.53)a |
1655 (5 studies) | Not reported |
| Bloodstream infection |
No difference OR: 0.74; 95% CI 0.37–1.50 |
||||
|
Hua et al. [63] China |
CHX (mouth rinse or gel) versus placebo/usual care | VAP |
CHX reduced VAP RR 0.75 (95% CI 0.62–0.91) |
2451(18 studies) | ⨁⨁⨁⨁ High |
| Mortality |
No difference RR 1.09 (95% CI 0.96–1.23) |
2014(14 studies) | ⨁⨁⨁◯ Moderate | ||
| ICU stay |
No difference 0.21 (95%CI -1.48 -1.89) |
833 (6 studies) | ⨁⨁⨁◯ Moderate | ||
|
Villar et al. [70] Brazil |
CHX (0.12–2% solution, gel or foam) versus placebo or usual care | VAP |
No difference with 0.1 and 0.2% 2% CHX reduced VAP RR:0.53 (95% CI 0.31–0.91) |
1640 (13 studies) | Not reported |
|
Klompas et al. [47] USA |
Interventions: CHX (0.12–2% solution, or gel) versus placebo/usualcare | VAP |
CHX reduced VAP RR, 0.56 (95% CI, 0.41–0.77) in CS No significant difference for NCS RR, 0.88 (95% CI, 0.66–1.16) |
1868 (3 studies) | Not reported |
| Mortality |
No difference: CS RR, 0.88 (95% CI, 0.25–2.14) NCS RR, 1.13, 95% CI, 0.99–1.29 |
1762 (13 studies) | Not reported | ||
|
Price et al. [48] UK |
SDD, SOD and topical oropharyngeal CHX versus usual care | Mortality |
SDD reduced mortality OR 0.73 (95%CI 0.64–0.84) |
7839 (15 studies) | Not reported |
|
SOD reduce mortality OR 0.85 (95%CI 0.74–0.97) |
4276 (4 studies) | Not reported | |||
|
CHX increased mortality OR 1.25 9% CI 1.05–1.50 |
2618 (11 studies) | Not reported |
CS, cardia surgery; NCS, non cardiac surgery; CHX, chlorhexidine; SDD, selective digestive decontamination; SOD, selective oropharyngeal decontamination; OR, odds ratio; RR, risk ratio
aCombined summary of interventions versus control