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Value of Whole-Body Washing With Chlorhexidine for the Eradication of Methicillin-Resistant Staphylococcus aureus: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Published online by Cambridge University Press:  02 January 2015

C. Wendt ,
S. Schinke ,
M. Württemberger ,
K. Oberdorfer ,
O. Bock-Hensley  and
H. von Baum
C. Wendt*
Affiliation:
Institute of Hygiene, University of Heidelberg, Heidelberg
S. Schinke
Affiliation:
Institute of Hygiene, University of Heidelberg, Heidelberg
M. Württemberger
Affiliation:
Institute of Hygiene, University of Heidelberg, Heidelberg
K. Oberdorfer
Affiliation:
Institute of Hygiene, University of Heidelberg, Heidelberg
O. Bock-Hensley
Affiliation:
Gesundheitsamt Rhein-Neckar Kreis, Heidelberg
H. von Baum
Affiliation:
Sektion Klinikhygiene, University of Ulm, Germany
*
Hygiene-Institut, University of Heidelberg, INF 324, 69 120 Heidelberg, Germany ([email protected])
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Abstract

Background.

Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistant Staphylococcus aureus (MRSA), but evidence for the effectiveness of this measure is limited.

Objective.

To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA.

Design.

Randomized, placebo-controlled, double-blinded clinical trial.

Setting.

University Hospital of Heidelberg and surrounding nursing homes.

Patients.

MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study.

Intervention.

Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites.

Results.

Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P = .02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P = .47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases.

Conclusion.

Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.

Trial Registration.

ClinicalTrials.gov identifier: NCT00266448.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 9 , September 2007 , pp. 1036 - 1043
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Loeb, M, Main, C, Walker-Dilks, C, Eady, A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev 2003;4:CD003340.Google Scholar
2. Gillespie, WA, Adler, VG, Ayliffe, GAJ, Powell, DEB, Wypkema, W. Control of staphylococcal cross-infection in surgical wards: a four-and-a-half-year study. Lancet 1961;1:1299–1303.Google Scholar
3. Hill, RL, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother 1988;22:377–384.Google Scholar
4. Murray-Leisure, KA, Geib, S, Graceley, D, et al. Control of epidemic methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 1990;11:343–350.CrossRefGoogle ScholarPubMed
5. Dancer, SJ, Poston, SM, East, J, Simmons, NA, Noble, WC. An outbreak of pemphigus neonatorum. J Infect 1990;20:73–82.CrossRefGoogle ScholarPubMed
6. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions of nosocomial infections. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
7. Mitteilung der Kommission für Krankenhaushygiene und Infektion-sprävention am RKI. Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in Krankenhäusern und anderen medizinischen Einrichtungen. Bundegesundheitsbl Gesundheitforsch Gesundheitsschutz 1999;42:954–958.CrossRefGoogle Scholar
8. von Baum, H, Schmidt, C, Svoboda, D, Bock-Hensley, O, Wendt, C. Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol 2002;23:511–515.Google Scholar
9. 2.6.1: Prüning auf Sterilität. In: European Pharmacopoeia. 4th ed. Stuttgart: Deutscher Apotheker Verlag, 2002:149–154.Google Scholar
10. National Committee for Clinical Laboratory Standards (NCCLS). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: NCCLS; 2003:M100-S13.Google Scholar
11. Pfaller, M, Hollis, RJ, Sader, HS. PFGE of chromosomal DNA. In: Isenberg, HD, ed. Clinical Microbiological Procedures Handbook. Washington, DC:American Society for Microbiology, 1992: Section 10.5.CGoogle Scholar
12. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
13. Simor, AE, Phillips, E, McGeer, A, et al. randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant Staphylococcus aureus colonization. Clin Infect Dis 2007;44:178–183.CrossRefGoogle ScholarPubMed
14. Lynch, W, Davey, PG, Malek, M, Byrne, DJ, Napier, A. Cost-effectiveness analysis of the use of chlorhexidine detergent in preoperative whole-body disinfection in wound infection prophylaxis. J Hosp Infect 1992;21:179–191.CrossRefGoogle ScholarPubMed
15. Davies, J, Babb, IR, Ayliffe, GA. The effect on the skin flora of bathing with antiseptic solutions. J Antimicrob Chemother 1977;3:473–481.Google Scholar
16. Mody, L, Kauffman, CA, McNeil, SA, Galecki, AT, Bradley, SF. Mupirocin-based decolonization of Staphylococcus aureus carriers in residents of 2 long-term care facilities: a randomized, double-blind placebo-controlled trial. Clin Infect Dis 2003;37:1467–1474.CrossRefGoogle ScholarPubMed
17. Balfour, A, Higgins, J, Brown, M, Gallacher, G. Eradication of throat carriage of methicillin-resistant Staphylococcus aureus . J Hosp Infect 1997;35:320–321.Google Scholar
18. Denton, WG. Chlorhexidine. In: Block, SS, ed. Disinfection, Sterilization and Preservation. 4th ed. Lea and Febiger: Philadelphia, 1991:274–289.Google Scholar
19. Kampf, G, Kramer, A. Eradication of methicillin-resistant Staphylococcus aureus with an antiseptic soap and nasal mupirocin among colonized patients—an open uncontrolled clinical trial. Ann Clin Microbiol Antimicrob 2004;3:9.Google Scholar
20. Rohr, U, Mueller, C, Wilhelm, M, Muhr, G, Gatermann, S. Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride. J Hosp Infect 2003;54:305–309.CrossRefGoogle ScholarPubMed
21. Dreyden, MS, Dailly, S, Crouch, M. A randomized, controlled trial of tea tree topical preparations versus standard topical regimen for the clearance of MRSA colonization. J Hosp Infect 2004;56:283–286.CrossRefGoogle Scholar
22. Sloot, N, Siebert, J, Höffler, U. Eradication of MRSA from carriers by means of whole-body washing with an antiseptic in combination with mupirocin nasal ointment. Zentrabl Hyg Umweltmed 1999;202:513–523.Google Scholar
23. Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 1999;43:1412–1416.CrossRefGoogle ScholarPubMed
24. Mahara, B, van Halteren, J, Verzijl, JM, Wintermanns, RG, Buiting, AG. Decolonization of methicillin-resistant Staphylococcus aureus using oral vancomycin and mupirocin. Clin Microbiol Infect 2002;8:671–675.CrossRefGoogle Scholar
25. Asensio, A, Guerrero, A, Quereda, C, Lizán, M, Martinez-Ferrer, M. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996;17:20–28.CrossRefGoogle ScholarPubMed
26. Rengelshausen, J, Nürnberger, J, Philipp, T, Kribben, A. Decolonization of methicillin-resistant Staphylococcus aureus by disinfection of the skin. Am J Med 2000;108:685–686.CrossRefGoogle ScholarPubMed
27. Safdar, N, Narans, L, Gordon, B, Maki, DG. Comparison of culture screening methods for detection of nasal carriage of methicillin-resistant Staphylococcus aureus: a prospective study comparing 32 methods. J Clin Microbiol 2003;41:3163–3166.Google Scholar
28. Bacon, AE, Jorgensen, KA, Wilson, KH, Kauffman, CA. Emergence of nosocomial methicillin-resistant Staphylococcus aureus and therapy of colonized personnel during a hospital-wide outbreak. Infect Control 1987;8:145–150.Google Scholar
29. Bitar, CM, Mayhall, CG, Lamb, VA, Bradshaw, TJ, Spadora, AC, Dalton, HP. Outbreak due to methicillin- and rifampin-resistant Staphylococcus aureus: epidemiology and eradication of the resistant strain from the hospital. Infect Control 1987;8:15–23.CrossRefGoogle ScholarPubMed
30. Law, MR, Gill, ON, Turner, A. Methicillin-resistant Staphylococcus aureus: associated morbidity and effectiveness of control measures. Epidemiol Infect 1988;101:301–309.Google Scholar
31. Valls, V, Gomez-Herruz, P, Gonzalez-Palacios, R, Cuadros, JA, Romanyk, JP, Ena, J. Long-term efficacy of a program to control methicillin-resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1994;13:90–95.CrossRefGoogle ScholarPubMed
32. Dutch Working Party on Infection Prevention. MRSA in nursing homes, 2005. Available at: http://www.wip.nl/UK/. Accessed February 9, 2007.Google Scholar