Chlorhexidine and tooth-brushing as prevention strategies in reducing ventilator-associated pneumonia rates

Nurs Crit Care. 2011 Nov-Dec;16(6):295-302. doi: 10.1111/j.1478-5153.2011.00465.x. Epub 2011 Jul 26.


Background: Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation after endotracheal intubation. The role of chlorhexidine and tooth-brushing has been considered as a clinical intervention to reduce infection rates, however, evidence to inform this needs appraising.

Aim: This paper presents a critical review on the effect of chlorhexidine gluconate (CHX) and tooth-brushing in decreasing rates of VAP in mechanically ventilated adult patients cared for in intensive care settings.

Methods: A literature search was conducted using a number of bibliographic databases (n = 6). A number of parameters were used to exclude irrelevant papers. A total n = 17 papers were located and accessed, which were directly related to the field. Eight studies that met the criteria and addressed the study aims were reviewed.

Findings: CHX was successful in reducing the rate of VAP and using a combination of CHX and colistine resulted in better oropharyngeal decontamination which reduced and delayed VAP. Chlorhexidine was also effective in reducing dental plaque in patients cared for in intensive care and had the potential to reduce nosocomial infections. Results of studies investigating the use of tooth-brushing in reducing VAP incidence proved inconsistent, although all recommend tooth-brushing as important in maintaining good oral hygiene.

Conclusions: The use of chlorhexidine has been proven to be of some value in reducing VAP, although may be more effective when used with a solution which targets gram-negative bacteria. Tooth-brushing is recommended in providing a higher standard of oral care to mechanically ventilated patients and reducing VAP when used with chlorhexidine. However, limitations in study design and inconsistency in results suggest that further research is required into the effects of tooth-brushing.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-Infective Agents, Local / therapeutic use
  • Chlorhexidine / analogs & derivatives*
  • Chlorhexidine / therapeutic use
  • Dental Plaque / drug therapy
  • Humans
  • Pneumonia, Bacterial / prevention & control*
  • Pneumonia, Ventilator-Associated / drug therapy
  • Pneumonia, Ventilator-Associated / prevention & control*
  • Toothbrushing*
  • Ventilators, Mechanical / adverse effects


  • Anti-Infective Agents, Local
  • chlorhexidine gluconate
  • Chlorhexidine