{
  "abstract": "Background\n\nChlorhexidine (CHX) has been a long-standing component of oral-care bundles for preventing ventilator-associated pneumonia (VAP), but recent evidence has questioned its benefit in non-cardiac-surgery ICU. We evaluated whether adding 0.12% CHX to standardized oral-care bundle provides incremental benefit in a mixed medical ICU.Methods\n\nWe conducted a prospective, pragmatic cluster-randomized crossover (AB/BA) trial in six adult medical ICUs of a single tertiary-care academic hospital in Bhubaneswar, India. ICUs were randomized as three ICUs of two Period of 9 months with the multicomponent oral-care bundle without chlorhexidine and three with the same bundle plus 0.12% chlorhexidine with a 1-month wash-in and re-training interval. Consecutive adults ventilated for ≥ 48 h were included. The primary outcome was VAP incidence density (Clinical Pulmonary Infection Score (CPIS) > 6) as per 1,000 ventilator-days. Secondary outcomes were 28-day all-cause mortality, duration of mechanical ventilation, ICU length of stay, 28- day ventilator-free days, Beck Oral Assessment Scale (BOAS) and Critical-Care Pain Observation Tool (CPOT) scores. The primary model was a population-averaged Poisson generalized estimating equation (GEE) and adjustment for treatment, period, sequence, age, sex, APACHE II, and SOFA.Results\n\nA total of 1,035 patients (637 No CHX, 398 CHX) accrued 10,024 ventilator-days (5,918 vs. 4,106). Groups were well balanced at baseline (mean age ≈ 55 years; APACHE II ≈ 19.6; SOFA ≈ 13.4). VAP occurred in 100/5,918 ventilator-days (16.9 per 1,000) vs. 77/4,106 (18.8 per 1,000) (No CHX vs. CHX). The adjusted Poisson incidence rate ratio was 1.08 (95% CI 0.84-1.38; p = 0.56). 28-day mortality was 28.7% vs. 26.4% (no CHX vs. CHX) (adjusted OR 0.87, 95% CI 0.65-1.15; p = 0.33). ICU length of stay was longer in the CHX arm (adjusted mean difference + 0.89 days, 95% CI + 0.19 to + 1.58; p = 0.013). BOAS and CPOT scores did not differ.Conclusions\n\nIn this trial, adding 0.12% chlorhexidine to a standardized oral-care bundle did not reduce VAP incidence density or 28-day mortality and was associated with a modest increase in ICU length of stay. Routine CHX use provided no clear incremental benefit in a mixed medical ICU population.Trial registration\n\nClinical Trials Regisrty- India (CTRI) identifier [CTRI/2024/02/062201], registered [01 February 2024].",
  "abstract_shown": true,
  "affiliations": [
    "Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India.",
    "Department of Respiratory Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India.",
    "Department of Critical Care Medicine, Institute of Medical Sciences and SUM Hospital, Siksha 'O' Anusandhan (Deemed to be University), Bhubaneswar, 751003, Odisha, India. samirsamal@soa.ac.in.",
    "Department of Critical Care Medicine, Medeor 24x7 Hospital, Abu Dhabi, 40330, United Arab Emirates."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "S Anushapreethi",
      "orcid": "0000-0003-3175-7092"
    },
    {
      "affs": [
        1
      ],
      "name": "Pritam Chhotray",
      "orcid": "0000-0002-1996-1181"
    },
    {
      "affs": [
        2
      ],
      "name": "Samir Samal",
      "orcid": "0000-0002-2496-1434"
    },
    {
      "affs": [
        0
      ],
      "name": "Sagarika Panda",
      "orcid": "0000-0002-8547-5720"
    },
    {
      "affs": [
        3
      ],
      "name": "Rohit Patnaik",
      "orcid": "0000-0002-2321-0743"
    },
    {
      "affs": [
        0
      ],
      "name": "Shakti Bedanta Mishra",
      "orcid": "0000-0001-6634-1877"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dn34p37nj3xvx.bib",
  "cited_by": 0,
  "doi": "10.1186/s13054-026-06217-0",
  "fulltext_url": "https://europepmc.org/articles/PMC13721277",
  "id": "dn34p37nj3xvx",
  "issns": [
    "1364-8535",
    "1466-609X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42958418",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2706|Nosocomial Infections in ICU"
    ]
  ],
  "openalex": "W7224519552",
  "pdf_url": "https://europepmc.org/articles/PMC13721277?pdf=render",
  "pmcid": "PMC13721277",
  "pmid": "42958418",
  "published": "2026-10-29",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/dn34p37nj3xvx.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:36Z",
      "native_id": "MED:42958418",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42958418"
    },
    {
      "first_seen": "2026-11-03T12:22:00Z",
      "native_id": "PMC13721277",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13054-026-06217-0"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2706|Nosocomial Infections in ICU",
      "subfield": "general"
    }
  ],
  "title": "Chlorhexidine within a standardized oral-care bundle for the prevention of ventilator-associated pneumonia: a pragmatic cluster-randomized crossover trial in six medical intensive care units.",
  "title_text": "Chlorhexidine within a standardized oral-care bundle for the prevention of ventilator-associated pneumonia: a pragmatic cluster-randomized crossover trial in six medical intensive care units.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:22:00Z",
  "url": "https://research.draconitic.com/paper/dn34p37nj3xvx",
  "venue": "Critical care (London, England)",
  "versions": []
}