Methicillin-resistant Staphylococcus Aureus (MRSA) Skin and Soft Tissue Infection (SSTI) Prevention in Military Trainees
Condition: Staphylococcus Aureus; MRSA Skin Infections; Staphylococcal Skin Infections
MeSH terms: Infections; Communicable Diseases; Staphylococcal Infections; Soft Tissue Infections; Cellulitis; Skin Diseases, Infectious; Staphylococcal Skin Infections
Study type: Interventional

Summary: 
      This cluster-randomized prospective study will evaluate the effect of hygiene-based
      intervention strategies on the incidence of overall SSTI and MRSA-associated SSTI among
      military trainees. The proposed interventions used singly or in combination include
      standardized training and education, and weekly chlorhexidine showers.
    

Detailed description: 
      MRSA SSTIs have become endemic in congregate community settings where there is frequent close
      person-to-person contact, such as athletic teams, correctional facilities, and military
      training facilities. These infections interfere with the mission of training soldiers as they
      impair soldiers' ability to participate in required activities and successfully complete a
      training program. Hygiene-based prevention programs (e.g., hand washing, environmental
      disinfection, and community-based education) appear to be effective in stemming outbreaks of
      MRSA SSTIs and need to by systematical evaluated.

      This cluster-randomized prospective study will evaluate the effect of hygiene-based
      intervention strategies on the incidence of overall SSTI and MRSA-associated SSTI among
      military trainees. The study population will be drawn from six training battalions, each
      consisting of an average of six companies. Each company is composed of four platoons
      consisting of approximately 50 trainees. Training battalions are the unit of randomization in
      this study and sub-clusters (platoons within companies) within each battalion will receive
      the same hygiene-based intervention assigned to that battalion at study start. During the
      proposed 20-month evaluation period, five cycles of platoons (approximately 14 weeks per
      cycle) will enter and exit training activities. In total, the study population will be
      comprised of approximately 36,000 trainees observed over a 20-month period. Each of the six
      battalions will receive an in-processing preventive medicine briefing augmented with MRSA
      prevention information based on U.S. Army Center for Health Promotion and Preventive Medicine
      (USACHPPM) and Centers for Disease Control and Prevention (CDC) recommendations.
      Additionally, trainees who seek medical care for a SSTI will receive standardized care at a
      SSTI clinic applying uniform practice guidance. Four of the battalions will also receive
      supplemental SSTI education for trainees and drill sergeants, including standardized guidance
      on SSTI surveillance (e.g., skin inspection) for drill sergeants; trainees will be instructed
      to take a 10 minute shower with soap every Sunday while in garrison; and will be issued a
      personal first aid kit. Two of these four battalions will be offered chlorhexidine antiseptic
      body wash to use during the Sunday shower. Endpoints of the evaluation (i.e., incident SSTIs
      among military trainees) will be captured through clinical record review at the completion of
      training.
    

Intervention name(s): Chlorhexidine gluconate; Supplemental training, education and hygiene
Intervention type(s): Drug; Other
Intervention description(s): Self applied chlorhexidine body wash (4% chlorhexidine gluconate, Hibiclens®, Mӧlnlycke Heath Care, Norcross, Georgia) once a week to wash/cover the body (except the face and genitalia).; Supplemental SSTI education for trainees and drill sergeants included pocket cards and posters. Drill sergeants received briefings on SSTI and skin inspection/minor wound care. Trainees were instructed to take an additional 10-minute shower with soap and a wash cloth every week. They were also issued a first aid kit.
Intervention MeSH terms: Chlorhexidine; Chlorhexidine gluconate
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Staphylococcus aureus; MRSA Skin Infection; Staphylococcal Skin Infections; Chlorhexidine gluconate