Does alternate-day bathing with 2% chlorhexidine improve clinical outcomes in critically ill patients? A systematic review and meta-analysis.

OBJECTIVE

To evaluate the effect of 2% chlorhexidine gluconate (2%CHG) bathing every other day on the number of infections, catheter-related bloodstream infections (CLABSI), average length of stay, and number of deaths.

METHODS

This is a systematic review and meta-analysis. The searches and data extraction were performed by two independent authors in six databases in February 2026. We calculated Risk Ratios (RR) and Mean Difference (MD) with 95% confidence intervals for all analyses.

RESULTS

Three studies were eligible for inclusion, comprising one randomized study, one quasi-experimental study, and one observational study, with a total population of 4,943 patients. There was no statistically significant difference between the 2% CHG and the control group for CLABSI (RR 0.98 [95% CI: 0.72; 1.31], p = 0.87, I2 = 0%), Gram-positive infections (RR 0.99 [95% CI: 0.45; 2.20], p = 0.98, I2 = 11%), Gram-negative infections (RR 1.23 [95% CI: 0.76; 1.99], p = 0.39, I2 = 0%), CRAB infections (RR 1.79 [95% CI: 0.54; 5.92], p = 0.34; I²=78%) or VRE infections (RR 0.53 [95% CI: 0.20; 1.42], p = 0.21, I²=0%), Similarly, alternate-day 2%CHG bathing was not associated with a significant reduction in ICU length of stay (MD 0.62 [95% CI: -0.29; 1.52], p = 0.18, I2 = 45%), hospital length of stay (MD 7.92 [95% CI: -1.92; 17.76], p = 0.11, I2 = 79%), ICU deaths (RR 1.02 [95%CI 0.88; 1.19]; p = 0.77; I² = 0%), or in-hospital deaths (RR 1.01 [95%CI 0.91; 1.12]; p = 0.84; I²=0%).

CONCLUSION

Given that only three studies were available for inclusion and that the certainty of evidence ranged from low to very low, no definitive conclusions can currently be drawn regarding the effectiveness of alternate-day 2% CHG bathing in critically ill patients.