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Chlorhexidine‐Impregnated Cloths to Prevent Skin and Soft‐Tissue Infection in Marine Recruits: A Cluster‐Randomized, Double‐Blind, Controlled Effectiveness Trial

Timothy J. Whitman , DO, Rachel K. Herlihy , MD, MPH, Carey D. Schlett , MPH, Patrick R. Murray , PhD, Greg A. Grandits , MS, Anuradha Ganesan , MD, Maya Brown , BA, James D. Mancuso , MD, MPH, William B. Adams , MD and David R. Tribble , MD, DrPH
Infection Control and Hospital Epidemiology
Vol. 31, No. 12 (December 2010), pp. 1207-1215
DOI: 10.1086/657136
Stable URL: http://www.jstor.org/stable/10.1086/657136
Page Count: 9
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Chlorhexidine‐Impregnated Cloths to Prevent Skin and Soft‐Tissue Infection in Marine Recruits: A Cluster‐Randomized, Double‐Blind, Controlled Effectiveness Trial
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Abstract

Background.  Community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) causes skin and soft‐tissue infection (SSTI) in military recruits. Objective.  To evaluate the effectiveness of 2% chlorhexidine gluconate (CHG)–impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits. Design.  A cluster‐randomized (by platoon), double‐blind, controlled effectiveness trial. Setting.  Marine Officer Candidate School, Quantico, Virginia, 2007. Participants.  Military recruits. Intervention.  Application of CHG‐impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly. Measurements.  Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization. Results.  Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG‐impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6‐week period. The mean 6‐week SSTI rate in the CHG‐impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin‐susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG‐impregnated and control cloth groups, respectively. Conclusions.  CHG‐impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG‐impregnated cloth intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits. Clinical trials registration.  ClinicalTrials.gov identifier: NCT00475930.

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