ABSTRACT
OBJECTIVE: To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination. DESIGN: Randomized, controlled trial. SETTING: County Jail, Dallas, Texas. PARTICIPANTS: A total of 4,196 detainees in 68 detention tanks. METHODS: Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months. RESULTS: At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [-4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%-20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [-1.4% to 18.0%]; P = .099) in group 2. CONCLUSIONS: Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00785200.
Subject(s)
Carrier State , Chlorhexidine/therapeutic use , Clothing , Disinfection/methods , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections/prevention & control , Adult , Anti-Infective Agents, Local/therapeutic use , Carrier State/diagnosis , Carrier State/microbiology , Carrier State/therapy , Female , Humans , Male , Methicillin-Resistant Staphylococcus aureus/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Prisons , Skin/microbiology , Treatment OutcomeABSTRACT
In 928 Dallas County Jail detainees, nasal carriage of Staphylococcus aureus was found in 32.8% (26.5% methicillin-susceptible Staphylococcus aureus [MSSA] and 6.3% methicillin-resistant S. aureus [MRSA]), and hand carriage was found in 24.9% (20.7% MSSA and 4.1% MRSA). Among MRSA nasal carriers, 41% had hand MRSA carriage; 29% with hand MRSA carriage had no nasal S. aureus carriage. The prevalence of carriage was not associated with duration of the jail stay up to 180 days.
