A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization
Introduction
It is common practice to attempt to clear methicillin-resistant Staphylococcus aureus (MRSA) carriage in hospital patients with topical antimicrobials and antiseptics. Our routine practice is to isolate and barrier-nurse all patients known to be colonized with MRSA and administer topical eradication therapy. The aim of this approach is to reduce the risk to the patient of infection with a resistant pathogen, reduce transmission of MRSA to other patients and staff, and if eradication is successful, to remove the need for barrier nursing or isolation of the patient. While it has been argued that this is not an efficient process,1 UK national guidelines recommend an attempt to eradicate MRSA in most hospital patients.2
The oil of the tea tree (Melaleuca alternifolia) is a popular ‘natural’ antiseptic with a broad spectrum of anti-microbial activity including MRSA,3., 4., 5. suggesting that this agent may be useful for skin antisepsis. Australian aborigines have used the plant medicinally for millennia.3 The oil is a complex mixture of agents but the main active ingredient is terpinen-4-ol. It has been incorporated in a wide variety of domestic products including soap, shampoo and household antiseptic creams. There is little published evidence on the value of its use in contemporary medical settings. Its use has been advocated in past decades for furunculosis,6 superficial fungal infections,7., 8. anaerobic vaginosis,9., 10. and eradication of head lice. In November 2000, a review of evidence for the efficacy against MRSA11 failed to include any clinical data. Since then one study showed that topical tea tree preparations were more effective than standard regimens for eradicating MRSA carriage, but the numbers of patients were very small.12
The aim of the present study was to compare the efficacy of topical tea tree preparations with the standard regimen for the eradication of MRSA colonization in patients in a 550 acute-bedded hospital and to assess their safety. At the time the standard eradication regimen was application of mupirocin (Bactroban) cream to the anterior nostrils and small open skin lesions, silver sulfadiazine ointment to open skin lesions and ulcers, and chlorhexidine washes to axillae and groin areas for five days.
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Patients
The study, which was approved by the local research ethics committee, was conducted in the Royal Hampshire County Hospital, Winchester between March 2001 and May 2002. All patients colonized with MRSA were considered eligible for entry, but those unable to give informed consent; known to be sensitive to tea tree oil; under the age of 16; pregnant or breast feeding were excluded. Patients who consented were randomly allocated either regimen by a balanced randomization method (block size of 10;
Results
Two hundred and thirty-six patients were entered in the study; follow-up swabs were not received for 12, so 224 were evaluable. One hundred and fourteen patients received ST of which 56 (49%) were cleared of MRSA carriage. One hundred and ten received TT and 46 (41%) were cleared (Table II). There was no significant difference between treatment regimens (P=0.0286 Fisher's exact test)
Seventy-four ST patients had nasal carriage and 58 (78%) had carriage eradicated by intra-nasal mupirocin. Six
Discussion
MRSA challenges and, in some cases, exhausts the resources of infection control teams. In this hospital we maintain an active approach to MRSA control. Our strategy of limited screening of patients awaiting orthopaedic and vascular surgery before admission to hospital, inter-hospital transfers and nursing home admissions, and new admissions to the intensive care unit was aimed at identifying as many new admissions with MRSA as possible. By influencing their accommodation in the hospital the
Acknowledgements
This study received no external funding and the authors have no competing interests. Ord River Tea Tree Oil Pty Ltd (526 The Esplanade, Warners Bay, NSW 2282, Australia) supplied the tea tree preparations. We are most grateful to Paul Strife, Research and Development Support Unit, Salisbury General Hospital, Salisbury for statistical advice.
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