Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial.
BACKGROUND
Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistant Staphylococcus aureus (MRSA), but evidence for the effectiveness of this measure is limited.


OBJECTIVE
To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA.


METHODS
Randomized, placebo-controlled, double-blinded clinical trial.


METHODS
University Hospital of Heidelberg and surrounding nursing homes.


METHODS
MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study.


METHODS
Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites.


RESULTS
Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P=.02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P=.47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases.


CONCLUSIONS
Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.
Wendt
C
C
Hygiene-Institut, University of Heidelberg, 69 120 Heidelberg, Germany. constanze_wendt@med.uni-heidelberg.de
Schinke
S
S
Württemberger
M
M
Oberdorfer
K
K
Bock-Hensley
O
O
von Baum
H
H
D000281:Administration, Intranasal; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001494:Baths; D002353:Carrier State / Q000188:drug therapy*; D002710:Chlorhexidine / Q000008:administration & dosage*; D003428:Cross Infection / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D016712:Mupirocin / Q000008:administration & dosage; D009735:Nursing Homes; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects*
D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine