title: Hygiene strategies to prevent methicillin-resistant Staphylococcus aureus skin and soft tissue infections: a cluster-randomized controlled trial among high-risk military trainees.
abstract: 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.
  
  
  BACKGROUND
  NCT01105767.
authors.affiliation: Department of Medicine.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Ellis
authors.forename: Carey D
authors.initials: CD
authors.lastname: Schlett
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Millar
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Wilkins
authors.forename: Katrina B
authors.initials: KB
authors.lastname: Crawford
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Morrison-Rodriguez
authors.forename: Laura A
authors.initials: LA
authors.lastname: Pacha
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Gorwitz
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Lanier
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
mesh_terms: D000293:Adolescent; D000328:Adult; D004203:Disinfection / Q000379:methods; D006266:Health Education / Q000379:methods; D006801:Humans; D006920:Hygiene / Q000592:standards*; D015994:Incidence; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008889:Military Personnel; D011446:Prospective Studies; D018461:Soft Tissue Infections / Q000382:microbiology* / Q000517:prevention & control*; D013207:Staphylococcal Skin Infections / Q000382:microbiology* / Q000517:prevention & control*; D014481:United States; D055815:Young Adult
keywords: Staphylococcus aureus; chlorhexidine; methicillin-resistant Staphylococcus aureus (MRSA); military; skin and soft tissue infection