509. A randomized, controlled trial (RCT) of chlorhexidine (CHG)-soaked cloths to reduce MRSA and MSSA carriage prevalence in an urban jail
Session: Poster Abstract Session: Infection Control and Skin Hygiene
Friday, October 21, 2011
Room: Poster Hall B1
Background: CA-MRSA has become a common cause of infection in jails but few studies in a community setting have evaluated the use of interventions to limit its spread.  We set out to determine if cleaning the skin with chlorhexidine (CHG)-soaked cloths would decrease the prevalence of MRSA nares and/or hand carriage among detainees.

Methods: Detainees in 68 Dallas County Jail detention tanks were invited to enroll in an RCT.  Tanks were randomly assigned to 1 of 3 study groups:  detainees in group I received cloths to clean their entire skin surface that contained CHG, in group II received identical cloths containing only water, and in group III received no skin treatment.  For 6 months, enrollees in group I and II tanks received cloths 3 times per week.  On Tuesdays and Thursdays all newly arrived detainees were offered enrollment.  Nares and hand cultures for MSSA and MRSA were obtained from subjects entering the study during the initial enrollment month and from all current enrollees at 2 and 6 months.

Results: Among 947 detainees enrolled at baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and hand combined).  During the study, an additional 3249 detainees were enrolled for a total of 4196, representing an overall participation rate of approximately 47%.  Compliance among subjects in the cloth tanks decreased slightly from 90.4% of cloths accepted during the first month to 82.3% and 85.7% among the CHG and water tanks, respectively, during the last 3 months.  Among the 553 detainees in the study at 6 months, MRSA carriage was 10.4% among subjects in group III tanks and 8.7% among those in CHG tanks, yielding an estimated absolute risk reduction of 1.7% (p = 0.572, 95% CI = (-4.3, 7.8)).  In contrast, carriage of any S. aureus strain was 51.6% in group III tanks and only 40.7% among those in CHG tanks, yielding an absolute risk reduction of 10.9% (p = 0.043, 95% CI = (0.3, 21.5)).  This reduction was observed mainly among cultures taken from the hand.  Carriage among those treated with water-soaked cloths was 42.5% at 6 months, yielding an absolute risk reduction of 9.0% (p = 0.079, 95% CI = (-1.0, 19.1)).

Conclusion: Use of CHG cloths for 6 months in jail detainees significantly decreased the carriage of S. aureus.  A nonsignificant decrease was found in MRSA carriage. 


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Michael Z David, MD PhD1, Jane D. Siegel, MD2, Janet Henderson, MHA3, Kaming Lo, MPH4, Gregory Leos, MPH3, L. Phillip Schumm5, Esmaeil Porsa, MD, MPH6, Diana Zychowski, BS7, Alexis Taylor, BA7, Susan Boyle-Vavra, PhD1 and Robert S Daum, MD7, (1)The University of Chicago, Chicago, IL, (2)University of Texas Southwestern Medical Center, Dallas, TX, (3)Parkland Health & Hospital System, Dallas, TX, (4)Epidemiology and Public Health , University of Miami Miller School of Medicine, Miami, FL, (5)Health Studies, University of Chicago, Chicago, IL, (6)Dallas County Jail, Parkland Health and Hospital System, Dallas, TX, (7)Pediatrics, University of Chicago, Chicago, IL

Disclosures:

M. Z. David, Sage Products: Grant Investigator, Research support

J. D. Siegel, Sage Products: Grant Investigator, Research support

J. Henderson, Sage Products: Supported research project, Research support

K. Lo, Sage Products: research support, Research grant

G. Leos, Sage Products: research support, Research grant

L. P. Schumm, None

E. Porsa, None

D. Zychowski, Sage Products: research support, Research grant

A. Taylor, Sage Products: research support, Research grant

S. Boyle-Vavra, Sage Products: Grant Investigator, Research grant

R. S. Daum, Sage Products: Grant Investigator, Research grant

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