Routine Use of Chlorhexidine-Based Body Wash Associated with a Reduction in Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Military Trainees
Methods: A SSTI prevention trial was conducted from 5/2010-1/2012 among US Army Infantry training recruits undergoing 14-week training at Fort Benning, GA. There were three study groups with incrementally increased education and hygiene-based interventions: Standard (S), Enhanced Standard (ES), and Chlorhexidine (CHG). Participants completed a risk factor questionnaire and underwent anterior nares screening culture. Nasal specimens were processed by standard laboratory methods. We estimated the impact of chlorhexidine use on S. aureus nasal colonization among participants not diagnosed with SSTI during the study period.
Results: A total of 1706 trainees (469 S, 597 ES, 640 CHG) were included in the analysis. Of those randomized to the CHG group, 360 (56.3%) reported frequent (at least weekly) use of CHG. The prevalence of overall S. aureus colonization did not differ between those reporting frequent versus infrequent/no CHG use (53.3% vs. 56.8%, respectively; p=0.25). However, the prevalence of MRSA colonization was marginally lower among frequent users (2.5% vs. 4.7%; p=0.07). When adjusting for potential confounders, including season of training start, personal hygiene practices, and being in a class where a SSTI case had recently occurred, the odds of MRSA colonization were significantly lower among those reporting frequent versus infrequent/no CHG use (OR=0.35, 95%CI=0.16-0.76). There were no differences in the prevalence of colonization by USA300 versus non-USA300 types (OR=0.59, 95%CI=0.06-5.76).
Conclusion: Frequent use of chlorhexidine body wash was associated with a reduction in MRSA nasal colonization among high-risk military recruits. Hygiene-based strategies may contribute to MRSA SSTI prevention by reducing colonization and interrupting transmission of MRSA.
C. Schlett, None
T. Cui, None
K. Crawford, None
S. Morrison-Rodriguez, None
J. Lanier, None
D. Tribble, None
E. Millar, None
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