“To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination” David et al (2014).
David, M.Z., Siegel, J.D., Henderson, J., Leos, G., Lo, K., Iwuora, J., Porsa, E., Schumm, L.P., Boyle-Vavra, S. and Daum, R.S. (2014) A Randomized, Controlled Trial of Chlorhexidine-Soaked Cloths to Reduce Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Carriage Prevalence in an Urban Jail. Infection Control and Hospital Epidemiology. 35(12), p.1466-1473.
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%]; ). 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%]; ), and 42.8% (absolute risk reduction [95% CI], 8.3% [−1.4% to 18.0%]; ) 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.
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