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Reduction in Acute Gastrointestinal Infection among Military Trainees: Secondary Effects of a Hygiene-based Cluster-Randomized Trial for SSTI Prevention

Session: Poster Abstract Session: Clinical - Enteric Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Acute gastrointestinal infections (AGI) commonly occur in military populations and negatively impact both training and field operations. Handwashing has been shown to reduce AGI rates; however, the impact of chlorhexidine has not been assessed. We evaluated the effect of hygiene-based intervention strategies, which included weekly use of chlorhexidine body wash, on the incidence of AGI in military trainees.

Methods: This was a secondary objective of a field-based, cluster-randomized trial to evaluate the effect of hygiene-based intervention strategies on skin and soft-tissue infections (SSTI).  Participants were Infantry trainees at Fort Benning, GA from 5/2010-1/2012. There were three study groups with incrementally increased education and hygiene-based interventions: Standard (S), Enhanced Standard (ES), and Chlorhexidine (CHG). We compared the incidence of first-episode AGI between study groups.

Results: The study population consisted of 30,196 trainees (9,321 S, 10,858 ES, 10,026 CHG). During the study period, 780 cases of AGI were identified. The S group had an incidence density of 2.30 cases per 1,000 person-weeks (PW), while the ES group and CHG group had incidence densities of 1.62 and 1.91 cases per 1,000 PW, respectively.  When compared to the S group, both the ES and CHG groups had significantly decreased relative risk (RR) of AGI (RR=0.70, 95% CI=0.59-0.84; and RR=0.83, 95% CI=0.70-0.98, respectively). There was no difference in rates between ES and CHG groups. 

Conclusion: Additional hygiene education was associated with a decrease in the incidence of AGI. Hygiene-based strategies that include additional education are useful in preventing AGI in military trainees and may benefit other settings at risk for AGI.

Michael D'onofrio, MD, MPH1, Carey Schlett, MPH2,3,4, Eugene Millar, PhD5, Tianyuan Cui, MA4, Jeffrey Lanier, MD6, Natasha Law, MA4, David R. Tribble, MD, DrPH7 and Michael Ellis, MD8, (1)Preventive Medicine, Walter Reed Army Institute of Research, Silver Spring, MD, (2)Inf Dis Clin Res Prg, Uniform Serv Univ, Bethesda, MD, (3)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)Infectious Disease Clinical Research Program, Uniformed Services University, Rockville, MD, (5)Infectious Disease Clinical Research Program, Rockville, MD, (6)Family Medicine, Martin Army Community Hospital, Fort Benning, GA, (7)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (8)Department of Medicine, Uniformed Services University, Bethesda, MD


M. D'onofrio, None

C. Schlett, None

E. Millar, None

T. Cui, None

J. Lanier, None

N. Law, None

D. R. Tribble, None

M. Ellis, None

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