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A Randomized, Controlled Trial of Chlorhexidine-Soaked Cloths to Reduce Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Carriage Prevalence in an Urban Jail

Published online by Cambridge University Press:  10 May 2016

Michael Z. David ,
Jane D. Siegel ,
Janet Henderson ,
Greg Leos ,
Kaming Lo ,
Jerry Iwuora ,
Esmaeil Porsa ,
L. Philip Schumm ,
Susan Boyle-Vavra  and
Robert S. Daum
Michael Z. David*
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois Department of Pediatrics, University of Chicago, Chicago, Illinois Department of Health Studies, University of Chicago, Chicago, Illinois
Jane D. Siegel
Affiliation:
Parkland Hospital and Health System, Dallas, Texas University of Texas–Southwestern, Dallas, Texas
Janet Henderson
Affiliation:
Parkland Hospital and Health System, Dallas, Texas
Greg Leos
Affiliation:
Infectious Disease Data and Prevention Group, Texas Department of State Health Services, Austin, Texas
Kaming Lo
Affiliation:
Division of Public Health Sciences, University of Miami, Miami, Florida
Jerry Iwuora
Affiliation:
Parkland Hospital and Health System, Dallas, Texas
Esmaeil Porsa
Affiliation:
Parkland Hospital and Health System, Dallas, Texas
L. Philip Schumm
Affiliation:
Department of Health Studies, University of Chicago, Chicago, Illinois
Susan Boyle-Vavra
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Robert S. Daum
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
*
University of Chicago Department of Medicine, 5841 South Maryland Avenue, MC6054 Chicago, IL 60637 (mdavid@medicine.bsd.uchicago.edu).
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Abstract

Objective.

To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination.

Design.

Randomized, controlled trial.

Setting.

County Jail, Dallas, Texas.

Participants.

A total of 4,196 detainees in 68 detention tanks.

Methods.

Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months.

Results.

At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [−4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%–20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [−1.4% to 18.0%]; P = .099) in group 2.

Conclusions.

Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use.

Trial registration.

ClinicalTrials.gov identifier NCT00785200.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 12 , December 2014 , pp. 1466 - 1473
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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