Reevaluating Chlorhexidine Gluconate Oral Care in Mechanically Ventilated Patients: Evidence for De-implementation

Chlorhexidine gluconate (CHG) oral care was incorporated into ventilator bundles as a preventive strategy for ventilator-associated pneumonia. Recent evidence challenged the efficacy and safety of this long-standing practice. Systematic reviews and randomized controlled trials show minimal benefits (non-significant reduction in intensive care unit length of stay and ventilator days) and potential for harm (trend toward increased mortality). International and national consensus statements have withdrawn recommendations to use CHG for oral care. This article synthesizes the evidence supporting de-implementation of CHG oral care and outlines practical steps for adopting safer, evidence-aligned oral care protocols focused on toothbrushing for mechanically ventilated adults.