Program Schedule

638
Routine Use of Chlorhexidine-Based Body Wash Associated with a Reduction in Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Military Trainees

Session: Oral Abstract Session: Epidemiology of MRSA and Impact of Control Interventions
Friday, October 10, 2014: 11:15 AM
Room: The Pennsylvania Convention Center: 111-AB
Background: In a field-based, cluster-randomized trial among military recruits, weekly use of chlorhexidine-based body wash failed to prevent overall and methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). As a secondary objective of the trial, we collected nasal swabs to evaluate the impact of the intervention on Staphylococcus aureus colonization.

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.

Michael Ellis, MD1, Wei-Ju Chen, PhD2, Carey Schlett, MPH2, Tianyuan Cui, MA2, Katrina Crawford, MS2, Stephanie Morrison-Rodriguez, MPH2, Jeffrey Lanier, MD3, David Tribble, MD, DrPH2 and Eugene Millar, PhD2, (1)Department of Medicine, Uniformed Services University, Bethesda, MD, (2)Infectious Disease Clinical Research Program, Uniformed Services University, Rockville, MD, (3)Family Medicine, Martin Army Community Hospital, Fort Benning, GA

Disclosures:

M. Ellis, None

W. J. Chen, None

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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