Why it’s time to abandon antiseptic mouthwashes

Since the late 1990s, chlorhexidine mouthwashes have been progressively introduced in the routine nursing care of ventilated patients to modulate oral colonization and micro-aspiration of respiratory pathogens, and as such, to prevent ventilator-associated pneumonia (VAP). Chlorhexidine mouthwash nevertheless became a recommendation in ventilated general medical-surgical and post-operative cardio-surgical ICU patients, a decision that was likely influenced by the presumed overall safety profile of the product: “If it does not do the job, it will not harm either”. Because of this assumption chlorhexidine mouthwashes have been broadly implemented in intensive care units (ICUs), irrespective of the limited scientific evidence base. Since 2014, however, several studies suggesting an increased mortality risk associated with chlorhexidine mouthwash have raised doubt as to whether the practice is harmless after all (Table 1). [...]the nitrate-nitrite-NO pathway can also be interrupted by exposure to proton-pump inhibitors and antibiotics, drugs that are commonly used in very sick and often ventilated ICU patients.