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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

Published online by Cambridge University Press:  10 May 2016

Michael Z. David ,
Jane D. Siegel ,
Janet Henderson ,
Greg Leos ,
Kaming Lo ,
Jerry Iwuora ,
Esmaeil Porsa ,
L. Philip Schumm ,
Susan Boyle-Vavra  and
Robert S. Daum
Michael Z. David*
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois Department of Pediatrics, University of Chicago, Chicago, Illinois Department of Health Studies, University of Chicago, Chicago, Illinois
Jane D. Siegel
Affiliation:
Parkland Hospital and Health System, Dallas, Texas University of Texas–Southwestern, Dallas, Texas
Janet Henderson
Affiliation:
Parkland Hospital and Health System, Dallas, Texas
Greg Leos
Affiliation:
Infectious Disease Data and Prevention Group, Texas Department of State Health Services, Austin, Texas
Kaming Lo
Affiliation:
Division of Public Health Sciences, University of Miami, Miami, Florida
Jerry Iwuora
Affiliation:
Parkland Hospital and Health System, Dallas, Texas
Esmaeil Porsa
Affiliation:
Parkland Hospital and Health System, Dallas, Texas
L. Philip Schumm
Affiliation:
Department of Health Studies, University of Chicago, Chicago, Illinois
Susan Boyle-Vavra
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Robert S. Daum
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
*
University of Chicago Department of Medicine, 5841 South Maryland Avenue, MC6054 Chicago, IL 60637 ([email protected]).
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 12 , December 2014 , pp. 1466 - 1473
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

1. David, MZ, Mennella, C, Mansour, M, Boyle-Vavra, S, Daum, RS. Predominance of methicillin-resistant Staphylococcus aureus among pathogens causing skin and soft tissue infections in a large urban jail: risk factors and recurrence rates. J Clin Microbiol 2008;46:3222–3227.Google Scholar
2. Centers for Disease Control and Prevention. Public health dispatch: outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections—Los Angeles County, California, 2002–2003. MMWR Morb Mortal Wkly Rep 2003;52:88.Google Scholar
3. Pan, ES, Diep, BA, Carleton, HA, et al. Increasing prevalence of methicillin-resistant Staphylococcus aureus infection in California jails. Clin Infect Dis 2003;37:1384–1388.Google Scholar
4. Deger, GE, Quick, DW. The enduring menace of MRSA: incidence, treatment, and prevention in a county jail. J Correct Health Care 2009;15:174–178.Google Scholar
5. Talan, DA, Krishnadasan, A, Gorwitz, RJ, et al. Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008. Clin Infect Dis 2011;53:144–149.Google Scholar
6. Groom, AV, Wolsey, DH, Naimi, TS, et al. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:1201–1205.Google Scholar
7. Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.Google Scholar
8. Skiest, D, Brown, K, Hester, J, et al. Community-onset methicillin-resistant Staphylococcus aureus in an urban HIV clinic. HIV Med 2006;7:361–368.Google Scholar
9. Crum-Cianflone, N, Weekes, J, Bavaro, M. Recurrent community-associated methicillin-resistant Staphylococcus aureus infections among HIV-infected persons: incidence and risk factors. AIDS Patient Care STDS 2009;23:499–502.Google Scholar
10. Liu, C, Graber, CJ, Karr, M, et al. A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004–2005. Clin Infect Dis 2008;46:1637–1646.Google Scholar
11. Turabelidze, G, Lin, M, Wolkoff, B, Dodson, D, Gladbach, S, Zhu, B. Personal hygiene and methicillin-resistant Staphylococcus aureus. Emerg Infect Dis 2006;12:422–427.Google Scholar
12. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
13. Farley, JE, Ross, T, Stamper, P, Baucom, S, Larson, E, Carroll, KC. Prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus among newly arrested men in Baltimore, Maryland. Am J Infect Control 2008;36:644–650.CrossRefGoogle ScholarPubMed
14. Kassakian, SZ, Mermel, LA, Jefferson, JA, Parenteau, SL, Machan, JT. Impact of chlorhexidine bathing on hospital-acquired infections among general medical patients. Infect Control Hosp Epidemiol 2011;32:238–243.CrossRefGoogle ScholarPubMed
15. Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:2073–2079.Google Scholar
16. Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46:274–281.Google Scholar
17. Rao, N, Cannella, BA, Crossett, LS, Yates, AJ Jr, McGough, RL 3rd, Hamilton, CW. Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up. J Arthroplasty 2011;26:1501–1507.Google Scholar
18. Munoz-Price, LS, Hota, B, Stemer, A, Weinstein, RA. Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30:1031–1035.Google Scholar
19. Whitman, TJ, Herlihy, RK, Schlett, CD, et al. Chlorhexidine-impregnated cloths to prevent skin and soft-tissue infection in Marine recruits: a cluster-randomized, double-blind, controlled effectiveness trial. Infect Control Hosp Epidemiol 2010;31:1207–1215.Google Scholar
20. Whitman, TJ, Schlett, CD, Grandits, GA, et al. Chlorhexidine gluconate reduces transmission of methicillin-resistant Staphylococcus aureus USA300 among Marine recruits. Infect Control Hosp Epidemiol 2012;33:809–816.Google Scholar
21. Fritz, SA, Camins, BC, Eisenstein, KA, et al. Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial. Infect Control Hosp Epidemiol 2011;32:872–880.Google Scholar
22. Enright, MC, Day, NP, Davies, CE, Peacock, SJ, Spratt, BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000;38:1008–1015.Google Scholar
23. Lina, G, Piémont, Y, Godail-Gamot, F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999;29:1128–1132.Google Scholar
24. Boyle-Vavra, S, Ereshefsky, B, Wang, CC, Daum, RS. Successful multiresistant community-associated methicillin-resistant Staphylococcus aureus lineage from Taipei, Taiwan, that carries either the novel staphylococcal chromosome cassette mec (SCCmec) type VT or SCCmec type IV. J Clin Microbiol 2005;43:4719–4730.Google Scholar
25. International Working Group on the Classification of Staphylococcal Cassette Chromosome Elements (IWG-SCC). Classification of staphylococcal cassette chromosome mec (SCCmec): guidelines for reporting novel SCCmec elements. Antimicrob Agents Chemother 2009;53:4961–4967.Google Scholar
26. McCullagh, P, Nelder, JA. Generalized Linear Models. 2nd ed. London: Chapman & Hall, 1989.Google Scholar
27. Efron, B, Tibshirani, R. An Introduction to the Bootstrap. Vol. 57. New York: Chapman & Hall, 1993.Google Scholar
28. David, MZ, Taylor, A, Lynfield, R, et al. Comparing pulsed-field gel electrophoresis with multilocus sequence typing, spa typing, staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for Panton-Valentine leukocidin, arcA, and opp3 in methicillin-resistant Staphylococcus aureus isolates at a U.S. Medical Center. J Clin Microbiol 2013;51:814–819.Google Scholar
29. David, MZ, Siegel, J, Lowy, FD, et al. Asymptomatic carriage of sequence type 398, spa type t571 methicillin-susceptible Staphylococcus aureus in an urban jail: a newly emerging, transmissible pathogenic strain. J Clin Microbiol 2013;51:2443–2447.Google Scholar
30. Tattevin, P, Diep, BA, Jula, M, Perdreau-Remington, F. Long-term follow-up of methicillin-resistant Staphylococcus aureus molecular epidemiology after emergence of clone USA300 in San Francisco jail populations. J Clin Microbiol 2008;46:4056–4057.Google Scholar
31. Lowy, FD, Aiello, AE, Bhat, M, et al. Staphylococcus aureus colonization and infection in New York state prisons. J Infect Dis 2007;196:911–918.Google Scholar
32. Wootton, SH, Arnold, K, Hill, HA, et al. Intervention to reduce the incidence of methicillin-resistant Staphylococcus aureus skin infections in a correctional facility in Georgia. Infect Control Hosp Epidemiol 2004;25:402–407.Google Scholar
33. Elias, AF, Chaussee, MS, McDowell, EJ, Huntington, MK. Community-based intervention to manage an outbreak of MRSA skin infections in a county jail. J Correct Health Care 2010;16:205–215.Google Scholar
34. Lee, CJ, Sankaran, S, Mukherjee, DV, et al. Staphylococcus aureus oropharyngeal carriage in a prison population. Clin Infect Dis 2011;52:775–778.Google Scholar