Schlett Carey D, Grandits Greg A, Millar Eugene V, Whitman Timothy J, Tribble David R
Infectious Disease Clinical Research Program, Uniformed Services University, 4301 Jones Bridge Road, Building 28, Suite 201, Bethesda, MD 20814, USA.
Mil Med. 2012 Nov;177(11):1335-42. doi: 10.7205/milmed-d-12-00145.
A cluster-randomized trial evaluating the effectiveness of chlorhexidine gluconate-impregnated wipes against skin and soft tissue infections (SSTIs) and colonization with methicillin-resistant Staphylococcus aureus (MRSA) was conducted among military recruits attending Officer Candidate School at Marine Corps Base Quantico, Virginia. Participants were instructed to use the wipes thrice weekly and were monitored daily for SSTI. Surveys assessed frequency of wipe use as well as knowledge and attitudes regarding MRSA SSTI. Use of chlorhexidine gluconate-impregnated wipes failed to prevent SSTI; however, study adherence was moderate. Adherence with the study regimen (defined as use of > or = 50% of the wipes) was 65% at week 2 and declined to 49% by week 6. Adherence was approximately 59% in the first two classes and declined in later classes. One-third felt that use of the wipes was disruptive. Participants were knowledgeable about MRSA SSTI prevention measures. However, only 53% agreed that MRSA commonly causes skin infections in military training facilities. Understanding adherence and its determinants is needed to optimize prevention strategies that require self-administration. Future efforts should address barriers to adherence with prevention strategies in recruit training settings.
在弗吉尼亚州匡蒂科海军陆战队基地参加候补军官学校的新兵中，开展了一项整群随机试验，以评估葡萄糖酸氯己定浸渍擦拭巾预防皮肤和软组织感染（SSTIs）以及耐甲氧西林金黄色葡萄球菌（MRSA）定植的有效性。参与者被指示每周使用擦拭巾三次，并每天监测是否发生SSTI。调查评估了擦拭巾的使用频率以及对MRSA SSTI的知识和态度。使用葡萄糖酸氯己定浸渍擦拭巾未能预防SSTI；然而，研究依从性为中等。研究方案的依从性（定义为使用≥50%的擦拭巾）在第2周时为65%，到第6周时降至49%。前两个班级的依从性约为59%，在后续班级中有所下降。三分之一的人认为使用擦拭巾会造成不便。参与者了解MRSA SSTI的预防措施。然而，只有53%的人同意MRSA在军事训练设施中通常会引起皮肤感染。需要了解依从性及其决定因素，以优化需要自我管理的预防策略。未来的努力应解决新兵训练环境中预防策略依从性的障碍。
