RCT on Chlorhexidine Washes for MRSA Eradication

Wendt, C., Schinke, S., Wurttemberger, M., Oberdorfer, K., Bock-Hensley, O., & von Baum, H. (2007). Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureas: A randomized, placebo-controlled, double-blind clinical trial. Infect Control Hosp Epidemiol, 28: 1036-1043.

Chlorhexidine body washing, in addition to intranasal and oral antmicrobial agents, is frequently prescribed for eradication of MRSA in infected or colonized patients. However, there is insufficient evidence to support its efficacy. This study was the first randomized, placebo-controlled trial to examine the use of chlorhexidine body washes for MRSA eradication.

Participants were provided with 5 one liter bottles of either a 4% chlorhexidine solution or water with 0.1% polysorbate 20 that looked and smelled similar to the chlorhexidine. Bottles were provided by the pharmacist and study invesitagators and participants were blind to treatment. Participants were asked to wash daily for 5 days, using 1 bottle a day with a minimum contact time of 30 seconds.

The overall MRSA eradication rate at 30 days post-treatment was 8% for the treatment (tx) group and 13% for the control group. Samples from the groin area were significantly more negative for the tx group at day 3 post-treatment, but by day 5 the differences were not significant. Persons in the tx group were more likely to develop skin fissures (17.7% vs. 1.8%, p=0.01), more likely to report itching (41.5% vs. 10.9%, p=0.001), and more likely to report burning of the skin (50.0% vs. 9.1%, p<.001).

The study findings suggest that chlorhexidine body washing may reduce MRSA colonization in the short-term, particularly in the groin region, but not permanently eradicate it. Furthermore, the side-effects of the chlorhexidine washing, including development of skin fissures and itching, may foster an environment for MRSA to grow.