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

• Published in: Infection control and hospital epidemiology 2014-12, Vol.35 (12), p.1466-1473
• Main Authors: David, Michael Z., Siegel, Jane D., Henderson, Janet, Leos, Greg, Lo, Kaming, Iwuora, Jerry, Porsa, Esmaeil, Schumm, L. Philip, Boyle-Vavra, Susan, Daum, Robert S.
• Format: Article
• Language: English
• Subjects: Adult; Anti-Infective Agents, Local - therapeutic use; Armored vehicles; Carrier State - diagnosis; Carrier State - microbiology; Carrier State - therapy; Chlorhexidine - therapeutic use; Confidence interval; Disinfection - methods; Female; Gluconates; Humans; Infections; Jails; Male; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Nursing; Original Article; Polymerase chain reaction; Prisons; Skin - microbiology; Staphylococcal Infections - prevention & control; Staphylococcus aureus; Treatment Outcome; Water tanks; Water treatment
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/678606

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.