Effects of daily bathing with 2% chlorhexidine compared to bathing with soap and water on risk of death, clinical severity, and intensive care unit length of stay in critically ill patients: an updated systematic review and meta-analysis

To evaluate the effectiveness of daily bathing with 2% CHG compared with traditional SAW bathing on risk of death, clinical severity, and ICU length of stay in critically ill patients. Between November 10 and 30, 2025 two reviewers independently conducted literature searches in six databases (PubMed, Cochrane, Embase, Scopus, ScienceDirect, and Web of Science). We included studies published in indexed journals that met the predefined PICOTT criteria. We calculated Risk Ratio, Mean Difference and Standardized Mean Difference with 95% confidence intervals for all analysis using random-effects models. Ten studies were included, comprising a total of 33,860 patients. Of these, 18,102 (53.5%) received traditional bathing with SAW, while 15,758 (46.5%) received baths with 2% CHG. Bathing with 2% CHG did not reduce the risk of death (RR 0.93 95% CI 0.86; 1.00, p = 0.05, I²=4%) and did not reduce clinical severity scores (SMD − 0.09 95%CI − 0.33; 0.14; p = 0.43; I² = 95%), with both outcomes supported by very low certainty of evidence. Patients receiving 2% CHG bathing had a mean ICU length of stay 0.07 days longer than those receiving SAW in the ICU (MD 0.07 95% CI 0.04, 0.10, p < 0.001, I2 = 0%) However, the certainty of evidence was low and the magnitude of this effect is unlikely to be clinically meaningful. Daily bathing with 2% CHG was not associated with a statistically significant reduction in risk of death or clinical severity. A small increase in ICU length of stay (0.07 days) was observed.