title: Routine chlorhexidine gluconate use onboard navy surface vessels to reduce infection: A cluster randomized controlled trial.
abstract: Hand disinfection with chlorhexidine gluconate (CHG) is commonly used for preventing the spread of infection in medical institutions and the community, but studies on its use in military settings have been inconclusive. We examined the effects of CHG on morbidity in Israeli Navy ships.
  
  
  
  This was a controlled, cluster randomized study that took place at a major naval base in Israel. Ships were randomly selected into the study (347 sailors) and primary control (350 sailors) groups. Additional nonintervention control groups included other sailors serving on the base (n = 360) and logistics and support personnel (n = 859). CHG disinfection devices were installed on all ships in the study group, alongside soap and water. Morbidity was analyzed using a computerized patient record, subjective self-report questionnaires, and a sample of hand cultures. Compliance with hand hygiene was analyzed using a self-report hygiene attitudes questionnaire at the beginning of the trial and after 3 months. The study took place between May and September 2014.
  
  
  
  No significant differences were found between the groups in terms of sick days or light-duty days or in the number of acute gastrointestinal or respiratory cases. Sailors were found to have more skin infections than controls, but this was not significantly reduced by CHG. Hand cultures demonstrated that continuous use of CHG did not cause a reduction in colonization. There were no statistically significant differences in self-reported hygiene practices.
  
  
  
  CHG did not demonstrate any medical benefit over the use of soap and water onboard Israeli Navy ships.
authors.affiliation: Medical Branch, Israeli Navy, Tel Aviv, Israel; Israeli Defense Force Medical Corps, Tel Aviv, Israel; Hofstra Northwell School of Medicine Family Residency Program, Glen Cove, NY. Electronic address: liorfeldman@gmail.com.
authors.forename: Lior
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Medical Branch, Israeli Navy, Tel Aviv, Israel; Israeli Defense Force Medical Corps, Tel Aviv, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Galili
authors.affiliation: Medical Branch, Israeli Navy, Tel Aviv, Israel; Israeli Defense Force Medical Corps, Tel Aviv, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: Israeli Defense Force Medical Corps, Tel Aviv, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Hartal
authors.affiliation: Israeli Defense Force Medical Corps, Tel Aviv, Israel.
authors.forename: Nirit
authors.initials: N
authors.lastname: Yavnai
authors.affiliation: Medical Branch, Israeli Navy, Tel Aviv, Israel; Israeli Defense Force Medical Corps, Tel Aviv, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Netzer
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology / Q000517:prevention & control*; D006235:Hand Disinfection / Q000379:methods*; D006302:Health Services Research; D006801:Humans; D007557:Israel; D008297:Male; D008889:Military Personnel; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: Hand hygiene; Hand sanitizer; Infection prevention; Navy