Skip to main content Accessibility help
×
Home

Chlorhexidine-Impregnated Cloths to Prevent Skin and Soft-Tissue Infection in Marine Recruits: A Cluster-Randomized, Double-Blind, Controlled Effectiveness Trial

  • Timothy J. Whitman (a1), Rachel K. Herlihy (a2), Carey D. Schlett (a2), Patrick R. Murray (a3), Greg A. Grandits (a4), Anuradha Ganesan (a1) (a2) (a4), Maya Brown (a2) (a4), James D. Mancuso (a2) (a4), William B. Adams (a3) and David R. Tribble (a2) (a4)...

Abstract

Background.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes skin and soft-tissue infection (SSTI) in military recruits.

Objective.

To evaluate the effectiveness of 2% Chlorhexidine gluconate (CHG)-impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits.

Design.

A cluster-randomized (by platoon), double-blind, controlled effectiveness trial.

Setting.

Marine Officer Candidate School, Quantico, Virginia, 2007.

Participants.

Military recruits.

Intervention.

Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly.

Measurements.

Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization.

Results.

Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively.

Conclusions.

CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth Intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits.

Clinical Trials Registration.

ClinicalTrials.gov identifier: NCT00475930.

Copyright

Corresponding author

Division of Infectious Diseases, Department of Internal Medicine, National Naval Medical Center, 8901 Rockville Pike, Bethesda, MD, (Timothy.Whitman@med.navy.mil)

References

Hide All
1.Gorwitz, RJ, Jernigan, DB, Powers, JH, Jernigan, JA, Participants in the CDC Convened Experts' Meeting on Management of MRSA in the Community. Strategies for clinical management of MRSA in the community: summary of an experts' meeting convened by the Centers for Disease Control and Prevention. Atlanta, GA: Centers for Disease Control and Prevention, 2006.
2.Zinderman, CE, Conner, B, Malakooti, MA, LaMar, JE, Armstrong, A, Bohnker, BK. Community-acquired methicillin-resistant Staphylococcus aureus among military recruits. Emerg Infect Dis 2004;10(5):941944.
3.Wootton, SH, Arnold, K, Hill, HA, et al.Intervention to reduce the incidence of methicillin-resistant Staphylococcus aureus skin infections in a correctional facility in Georgia. Infect Control Hosp Epidemiol 2004;25(5):402407.
4.Kazakova, SV, Hageman, JC, Matava, M, et al.A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005;352(5):468475.
5.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):17631771.
6.Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and Chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28(10):11551161.
7.Ellis, MW, Griffith, ME, Dooley, DP, et al.Targeted intranasal mupirocin to prevent colonization and infection by community-associated methi¬cillin-resistant Staphylococcus aureus strains in soldiers: a cluster randomized controlled trial. Antimicrob Agents Chemother 2007;51(10):35913598.
8.Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46(2):274281.
9.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al.The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylo¬coccus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crif Care Med 2009;37(6):18581865.
10.Hibbard, JS. Analyses comparing the antimicrobial activity and safety of current antiseptic agents: a review. J Infus Nurs 2005;28(3):194207.
11. Chlorhexidine gluconate (CHG) compatibility. Cary, IL: Sage Products, 2006.
12. HALO 2% Chlorhexidine gluconate cloth [package insert]. Cary, IL: Sage Products; 2008.
13. Comfort Bath [package insert]. Cary, IL: Sage Products; 2008.
14.Buck, JM, Como-Sabetti, K, Harriman, KH, et al.Community-associated methicillin-resistant Staphylococcus aureus, Minnesota, 2000-2003. Emerg Infect Dis 2005;11(10):15321538.
15.Bannerman, T. Staphylococci and other catalase positive cocci that grow aerobically. In: Murray, PR BE, Jorgensen, JH, ed. Manual of Clinical Microbiology. 8th ed. Washington, DC: ASM Press, 2003:384404.
16.Clinical and Laboratory Standards Institute. M7-A7: Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. Wayne, PA: Clinical and Laboratory Standards Institute, 2006.
17.Clinical and Laboratory Standards Institute. M100-S17: Performance Standards for Antimicrobial Susceptibility Testing; 16th Informational Supplement. Wayne, PA: Clinical and Laboratory Standards Institute, 2007.
18.Simpson, JM, Klar, N, Donnor, A. Accounting for cluster randomization: a review of primary prevention trials, 1990 through 1993. Am J Public Health 1995;85(10):13781383.
19.Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39(7):971979.
20.Army Medical Surveillance Activity. Cellulitis and abscess, active components, US armed forces, 2002-2005. MSMR 2006;12(4):29.
21.Austin, PC. A comparison of the statistical power of different methods for the analysis of cluster randomization trials with binary outcomes. Stat Med 2007;26(19):35503565.
22.Thorpe, KE, Zwarenstein, M, Oxman, AD, et al.A pragmatic-explanatory continuum indicator summary (PRECIS): a tool to help trial designers. J Clin Epidemiol 2009;62(5):464475.
23.Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166(3):306312.
24.Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167(19):20732079.
25.Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with Chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30(10):959963.
26.Munoz-Price, LS, Hota, B, Stemer, A, Weinstein, RA. Prevention of bloodstream infections by use of daily Chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30(11):10311035.
27.Batra, R, Cooper, BS, Whiteley, C, Patel, AK, Wyncoll, D, Edgeworth, JD. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010;50(2):210217.
28.Darouiche, RO, Wall, MJ Jr, Itani, KM, et al.Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362(1):1826.
29.Wendt, C, Schinke, S, Wurttemberger, M, Oberdorfer, K, Bock-Hensley, O, von Baum, H. Value of whole-body washing with Chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol 2007;28(9):10361043.
30.Wertheim, HF, Melles, DC, Vos, MC, et al.The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5(12):751762.
31.Miller, LG, Diep, BA. Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46(5):752760.
32.Yang, ES, Tan, J, Eells, S, Rieg, G, Tagudar, G, Miller, LG. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect 2010;16(5):425431.
33.Begier, EM, Frenette, K, Barrett, NL, et al.A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39(10):14461453.
34.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al.Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355(7):666674.
35.Ammerlaan, HS, Kluytmans, JA, Wertheim, HF, Nouwen, JL, Bonten, MJ. Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009;48(7):922930.
36.Fernandez, C, Gaspar, C, Torrellas, A, et al.A double-blind, randomized, placebo-controlled clinical trial to evaluate the safety and efficacy of mupirocin calcium ointment for eliminating nasal carriage of Staphylococcus aureus among hospital personnel. J Antimicrob Chemother 1995;35(3):399408.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed