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Chlorhexidine-impregnated cloths to prevent skin and soft-tissue infection in Marine recruits: a cluster-randomized,
Timothy J Whitman1, Rachel K Herlihy, Carey D Schlett
1Division of Infectious Diseases, Department of Internal Medicine, National Naval Medical Center, Bethesda, Maryland, USA. Timothy.Whitman@med.navy.mil
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.
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