A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail

Michael Z. David, Jane D. Siegel, Janet Henderson, Greg Leos, Kaming Lo, Jerry Iwuora, Esmaeil Porsa, L. Philip Schumm, Susan Boyle-Vavra, Robert S. Daum

Research output: Contribution to journalArticle

6 Citations (Scopus)

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

Original languageEnglish (US)
Pages (from-to)1466-1473
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume35
Issue number12
DOIs
StatePublished - 2014

Fingerprint

Methicillin Resistance
Methicillin
Chlorhexidine
Methicillin-Resistant Staphylococcus aureus
Numbers Needed To Treat
Staphylococcus aureus
Randomized Controlled Trials
Confidence Intervals
Skin
Hand
Water
chlorhexidine gluconate

ASJC Scopus subject areas

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail. / David, Michael Z.; Siegel, Jane D.; Henderson, Janet; Leos, Greg; Lo, Kaming; Iwuora, Jerry; Porsa, Esmaeil; Philip Schumm, L.; Boyle-Vavra, Susan; Daum, Robert S.

In: Infection Control and Hospital Epidemiology, Vol. 35, No. 12, 2014, p. 1466-1473.

Research output: Contribution to journalArticle

David, Michael Z. ; Siegel, Jane D. ; Henderson, Janet ; Leos, Greg ; Lo, Kaming ; Iwuora, Jerry ; Porsa, Esmaeil ; Philip Schumm, L. ; Boyle-Vavra, Susan ; Daum, Robert S. / A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail. In: Infection Control and Hospital Epidemiology. 2014 ; Vol. 35, No. 12. pp. 1466-1473.
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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",
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AU - David, Michael Z.

AU - Siegel, Jane D.

AU - Henderson, Janet

AU - Leos, Greg

AU - Lo, Kaming

AU - Iwuora, Jerry

AU - Porsa, Esmaeil

AU - Philip Schumm, L.

AU - Boyle-Vavra, Susan

AU - Daum, Robert S.

PY - 2014

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N2 - 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

AB - 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

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