Hygiene Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections: A Cluster-Randomized Controlled Trial Among High-Risk Military Trainees

摘要

>Background. Effective measures are needed to prevent methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) in high-risk community settings. The study objective was to evaluate the effect of personal hygiene–based strategies on rates of overall SSTI and MRSA SSTI.>Methods. We conducted a prospective, field-based, cluster-randomized trial in US Army Infantry trainees from May 2010 through January 2012. There were 3 study groups with incrementally increased education and hygiene-based interventions: standard (S), enhanced standard (ES), and chlorhexidine (CHG). The primary endpoints were incidence of overall SSTI and MRSA SSTI.>Results. The study included 30 209 trainees constituting 540 platoons (168 S, 192 ES, and 180 CHG). A total of 1203 (4%) participants developed SSTI, 316 (26%) due to MRSA. The overall SSTI rate was 4.15 (95% confidence interval [CI], 3.77–4.58) per 100 person-cycles. SSTI rates by study group were 3.48 (95% CI, 2.87–4.22) for S, 4.18 (95% CI, 3.56–4.90) for ES, and 4.71 (95% CI, 4.03–5.50) for CHG. The MRSA SSTI rate per 100 person-cycles for all groups was 1.10 (95% CI, .91–1.32). MRSA SSTI rates by study group were 1.0 (95% CI, .70–1.42) for S, 1.29 (95% CI, .98–1.71) for ES, and 0.97 (95% CI, .70–1.36) for CHG.>Conclusions. Personal hygiene and education measures, including once-weekly use of chlorhexidine body wash, did not prevent overall SSTI or MRSA SSTI in a high-risk population of military trainees.>Clinical Trials Registration. .