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Comment & Response |

Oral Hygiene With Chlorhexidine in Critically Ill Patients

Kirsty M. Sands, BSc1; Joshua A. Twigg, BDS2; Matt P. Wise, DPhil3
[+] Author Affiliations
1Tissue Engineering and Reparative Dentistry, School of Dentistry, Cardiff University, Cardiff, Wales
2Department of Oral and Maxillofacial Surgery, School of Dentistry, Cardiff University, Cardiff, Wales
3Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, Wales
JAMA Intern Med. 2015;175(2):316. doi:10.1001/jamainternmed.2014.7174.
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To the Editor In their systematic review and meta-analysis, Klompas et al1 assessed oral care with chlorhexidine gluconate in mechanically ventilated patients. The authors compared studies that included cardiac or non–cardiac surgery patients, concluding that there was only evidence of benefit, ie, less pneumonia, in the cardiac surgery population. There was also a suggestion that chlorhexidine might even be harmful in the non–cardiac surgery population, with the authors concluding that “[t]he lack of clear evidence that adding chlorhexidine to routine oral care benefits non–cardiac surgery patients should prompt reexamination of hospital policies mandating its use.”1(p758) This conclusion might be premature when one considers the mechanism of action of chlorhexidine.

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February 1, 2015
Michael Klompas, MD; Sean M. Berenholtz, MD
1Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, Boston, Massachusetts2Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
3Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland4Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland5Department 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.
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