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

doi:10.1086/678606

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

Pediatrics

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

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

Original language	English (US)
Pages (from-to)	1466-1473
Number of pages	8
Journal	Infection Control and Hospital Epidemiology
Volume	35
Issue number	12
DOIs	https://doi.org/10.1086/678606
State	Published - 2014

ASJC Scopus subject areas

Epidemiology
Microbiology (medical)
Infectious Diseases

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10.1086/678606

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David, M. Z., Siegel, J. D., Henderson, J., Leos, G., Lo, K., Iwuora, J., Porsa, E., Philip Schumm, L., Boyle-Vavra, S., & 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), 1466-1473. https://doi.org/10.1086/678606

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

Research output: Contribution to journal › Article › peer-review

David, MZ, Siegel, JD, Henderson, J, Leos, G, Lo, K, Iwuora, J, Porsa, E, Philip Schumm, L, Boyle-Vavra, S & Daum, RS 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, vol. 35, no. 12, pp. 1466-1473. https://doi.org/10.1086/678606

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

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",

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

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AU - Leos, Greg

AU - Lo, Kaming

AU - Iwuora, Jerry

AU - Porsa, Esmaeil

AU - Philip Schumm, L.

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AU - Daum, Robert S.

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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

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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

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