October 29, 2026 PubMed publication record · Pragmatic cluster-randomized crossover trial in six ICUs · Primary source
Some interventions become habits because they fit smoothly into care bundles. A pragmatic trial in six medical ICUs asked whether adding 0.12% chlorhexidine to otherwise standardized oral care prevented ventilator-associated pneumonia. The study focused on the incremental contribution of one common ingredient, not whether oral hygiene matters.
Across 1,035 patients and 10,024 ventilator-days, the pneumonia rate was 16.9 per 1,000 ventilator-days without chlorhexidine versus 18.8 with it. The adjusted incidence rate ratio was 1.08 (95% CI 0.84–1.38, P=0.56). Twenty-eight-day mortality was 28.7% without chlorhexidine and 26.4% with it, without a significant adjusted difference. The chlorhexidine periods were associated with ICU stays 0.89 days longer on average (95% CI 0.19–1.58).
The trial took place in one hospital system and used a defined clinical-pulmonary-infection score, so diagnostic standards and generalizability need consideration. It did not find a reduction in the main infectious outcome. That negative result is useful because it invites a practical question: which parts of our routines earn their burden and cost? This is a better patient-safety story than another general exhortation to improve adherence.
Clinical reading: Relevant to critical-care protocol appraisal; do not alter unit infection-control policy solely from one trial.
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Care & independence · Reading the evidence