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

Published online by Cambridge University Press:  02 January 2015

Timothy J. Whitman ,
Rachel K. Herlihy ,
Carey D. Schlett ,
Patrick R. Murray ,
Greg A. Grandits ,
Anuradha Ganesan ,
Maya Brown ,
James D. Mancuso ,
William B. Adams  and
David R. Tribble
Timothy J. Whitman*
Affiliation:
National Naval Medical Center, Bethesda, Maryland
Rachel K. Herlihy
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University
Carey D. Schlett
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University
Patrick R. Murray
Affiliation:
Division of Biostatistics, University of Minnesota, Minneapolis and Marine Corps Base, Quantico, Virginia
Greg A. Grandits
Affiliation:
National Institutes of Health, Bethesda, Maryland
Anuradha Ganesan
Affiliation:
National Naval Medical Center, Bethesda, Maryland Infectious Disease Clinical Research Program, Uniformed Services University National Institutes of Health, Bethesda, Maryland
Maya Brown
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University National Institutes of Health, Bethesda, Maryland
James D. Mancuso
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University National Institutes of Health, Bethesda, Maryland
William B. Adams
Affiliation:
Division of Biostatistics, University of Minnesota, Minneapolis and Marine Corps Base, Quantico, Virginia
David R. Tribble
Affiliation:
Infectious Disease Clinical Research Program, Uniformed Services University National Institutes of Health, Bethesda, Maryland
*
Division of Infectious Diseases, Department of Internal Medicine, National Naval Medical Center, 8901 Rockville Pike, Bethesda, MD, ([email protected])
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1207 - 1215
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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