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

Abstract

In a field-based trial among military trainees, personal hygiene measures, including chlorhexidine (CHG) body wash, did not prevent overall and methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). We conducted a secondary analysis of anterior nares cultures obtained during the trial to evaluate the impact of hygiene measures on Staphylococcus aureus colonization. A cluster-randomized trial for SSTI prevention was conducted among U.S. Army infantry trainees from May 2010 to January 2012. There were three study groups with incrementally increasing education-and hygiene-based components: standard (S), enhanced standard (ES), and CHG. Anterior nares cultures were obtained from participants to determine the prevalence of S. aureus colonization. A total of 1,706 participants (469 S, 597 ES, and 640 CHG) without SSTI were included in the colonization analysis. Of those randomized to the CHG group, 360 (56.3%) reported frequent use of body wash. Frequent use of body wash had no effect on overall S. aureus colonization (53.3% versus 56.8% among infrequent/nonusers; P ‫؍‬ 0.25). MRSA colonization prevalence was marginally lower among frequent users (2.5% versus 4.7%; P ‫؍‬ 0.07). In multivariable analysis, the odds of MRSA colonization were lower among frequent users (odds ratio [ Skin and soft-tissue infections (SSTI), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), have become increasingly common in communities. Individuals in congregate settings (e.g., athletes, inmates, and military personnel) are known to be at increased risk for SSTI (1-3). Among military personnel, infection rates are highest in trainees (4, 5). Because SSTI can interrupt training cycles and compromise operational readiness, effective SSTI prevention strategies for military populations are critically needed.In the absence of a vaccine for Staphylococcus aureus, hygienebased measures (e.g., hand washing, appropriate wound care, environmental disinfection, and patient education) comprise the current strategy for stemming SSTI outbreaks and preventing new cases of disease (1,3,6). As colonization has a demonstrated role in the pathogenesis and transmission of S. aureus, elimination of the carrier state with topical and systemic agents also has been employed as a prevention strategy (7-10). Nevertheless, the optimal method to prevent SSTI in congregate settings remains unknown.To date, two field-based randomized controlled trials for SSTI prevention, both using chlorhexidine gluconate (CHG), have been conducted among U.S. military trainees (11,12). Among recruits attending Officer Candidate School at Marine Corps Base, Quantico, Virginia, a thrice-weekly application of CHG-impregnated body cloths over a 6-week period did not reduce rates of SSTI (11). With respect to colonization, however, an analysis of nasal/axillary swabs showed a significant reduction in MRSA acquisition rates among CHG-randomized participants compared to the control (3.3% versus 6.5%; P ϭ 0.004) (13). More import...

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