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Hygiene-based approach failed to reduce SSTI rates in military trainees
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A combination of personal hygiene and education measures, including weekly chlorhexidine bathing, did not prevent MRSA skin and soft tissue infections among high-risk military trainees, according to researchers from the Uniformed Services University of the Health Sciences.
“These findings are in contrast to a hygiene-based intervention in another military trainee population that also employed weekly use of a chlorhexidine-based body wash,” the researchers wrote in Clinical Infectious Diseases. “Our data suggest that there may be a differential benefit of chlorhexidine against MRSA [skin and soft tissue infections] during the summer months.”
The researchers conducted a prospective, field-based, cluster-randomized trial from May 2010 to January 2010. The study included 30,029 US Army Infantry trainees, representing 540 platoons. There were three groups: standard intervention, enhanced standard intervention and chlorhexidine.
In the standard intervention group, the trainees received a preventive medicine briefing that was augmented with skin and soft tissue infection (SSTI) and MRSA SSTI prevention information and personal hygiene information. Those in the enhanced standard intervention group received the same and were instructed to take an additional 10-minute shower with soap and a wash cloth every week. They also received a first aid kit and supplemental SSTI education. Lastly, trainees in the chlorhexidine group received chlorhexidine body wash to use with a wash cloth once weekly, in addition to all of the components of the other groups.
The overall SSTI rate was 4.15 cases per 100 person-cycles, and the overall MRSA SSTI rate was 1.1 cases per 100 person-cycles. When the groups were compared, the researchers found that the overall SSTI rate was increased in the chlorhexidine group (RR=1.35; 95% CI, 1.06-1.73). However, the rates of MRSA SSTI did not differ between the groups.
“We did not observe a consistent benefit of enhanced education or surveillance,” the researchers wrote. “This finding does not undermine the importance of commonly recommended education and hygiene measures, nor does it suggest that they are not integral in controlling outbreaks or preventing disease in other community settings.”
Disclosure: The researchers report no relevant financial disclosures.
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