Background: Military trainees are known to be at high-risk for skin and soft tissue infections (SSTI) due to methicillin-resistant Staphylococcus aureus (MRSA). Between 2002 and 2005, the annual incidence of overall SSTI at one Marine Corps Recruit Training Facility (MCRTF) was 391.2 per 1,000 person-years, 2-4 times higher than that of similar recruit training settings and the highest among all recruit training facilities in the US. In December 2005, the command at the MCRTF implemented a hygiene-based intervention following a steady annual increase in the number of MRSA-associated SSTI cases from 2002-2005. The prevention strategy for recruits at the MCRTF included:  standardized personal hygiene practices,  periodic chlorhexidine showers upon entry into training and during times of rigorous field activity, and  enhanced clinic-based SSTI surveillance activities.
Objective: To assess the impact of a multi-component hygiene-based prevention program on rates of SSTI and MRSA-associated SSTI at the MCRTF.
Methods: We evaluated weekly surveillance data on SSTI and MRSA-associated SSTI. Annual rates of SSTI and MRSA-associated SSTI were calculated. Rate differences were assessed using an independent sample t-test.
Results: Annual SSTI rates peaked at 544 per 1000 person-years in 2004 and, following the December 2005 implementation of the intervention, declined thereafter to 298 per 1000 person-years in 2008. SSTI rates in the post-implementation period were 29% lower than the pre-implementation period (Figure 1). Similar trends in rates of MRSA-associated SSTI were observed, namely a decrease from 229 per 1000 person-years in 2004 to 45 per 1000 person-years in 2008. This represents a 65% reduction from the pre-implementation time period (P<0.001).
During a given week from 2003 through 2008, an average of 35 SSTIs and 10 MRSA-associated SSTIs were identified by the surveillance system. During the pre-intervention period, an average of 43 SSTIs and 15 MRSA-associated SSTIs per week were reported; following the intervention, an average of 30 SSTIs and 5 MRSA-associated SSTIs per week were reported.
Conclusions: Significant declines in rates of SSTIs and MRSA-associated SSTIs followed the implementation of a hygiene-based intervention among recruits at the MCRTF. Systematic evaluation of similar hygiene-based prevention strategies in other high incidence SSTI and MRSA-associated SSTI settings is warranted.