Project CLEAR - Changing Lives by Eradicating Antibiotic Resistance

NCT ID: NCT01209234

Last Updated: 2025-11-21

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

2140 participants

Study Classification

INTERVENTIONAL

Study Start Date

2011-01-31

Study Completion Date

2019-01-31

Brief Summary

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This randomized controlled trial will compare strategies to reduce the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection and re-hospitalization in MRSA carriers. This trial will provide critical answers about the role of decolonization versus standard-of-care education in preventing MRSA infections in the large group of high risk MRSA-positive patients being discharged from hospitals. Findings could potentially impact best practice for the 1.8 million MRSA carriers who are discharged from US hospitals each year.

Detailed Description

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This randomized controlled trial will compare strategies to reduce the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection and re-hospitalization in MRSA carriers. This trial will provide critical answers about the role of decolonization versus standard-of-care education in preventing MRSA infections in the large group of high risk MRSA+ patients being discharged from hospitals. Findings could potentially impact best practice for the 1.8 million MRSA carriers who are discharged from US hospitals each year.

Specific Aims:

Methicillin-resistant Staphylococcus aureus (MRSA) is arguably the most important single pathogen in healthcare-associated infection when accounting for virulence, prevalence, diversity of disease spectrum, and propensity for widespread transmission. MRSA infection causes or complicates 300,000 hospitalizations each year \[Klein, Smith, Laxminarayan\], a number which has doubled in the past five years. An additional 1.5 million hospitalized patients either acquire or already harbor the pathogen without current infection. Altogether, these 1.8 million MRSA inpatient carriers experience a high amount of MRSA invasive disease in the year following discharge. Due to increased delivery of complex medical care at home or other post-hospital settings, more and more patients experience serious healthcare-associated morbidity after hospital discharge.\[Huang, Platt; Huang, Hinrichsen, Stulgis et al.\] In fact, over 80% of patients admitted for MRSA infection have had prior healthcare exposures and are at high risk for repeated MRSA infection.\[Huang, Platt; Huang, Hinrichsen, Stulgis et al.; Klevens, Morrison, Nadle, et al.\]

Project CLEAR compares two strategies to reduce infection and re-hospitalization due to MRSA among patients being discharged from hospitals. Our trial will compare a long-term regimen aimed at eradicating MRSA body reservoirs with patient education on general hygiene and self care, which is the current standard of care. Our specific aims are:

* To conduct a randomized controlled trial of serial decolonization versus standard-of-care patient education among MRSA carriers upon hospital discharge to reduce post-discharge MRSA infection and re-hospitalization for one year
* To identify predictors of a) infection or re-hospitalization due to MRSA, and b) successful MRSA decolonization, including patient demographics, comorbidities, medical devices, risk behaviors, socioeconomic status, and colonizing MRSA genotype
* To estimate medical and non-medical costs of MRSA infection among MRSA carriers and evaluate the potential for cost savings associated with decolonization

Conditions

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Methicillin-resistant Staphylococcus Aureus

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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MRSA Decolonization

Participants in this arm will be instructed to complete a decolonization regimen that will involve a 5-day application of nasal mupirocin, oral CHG rinse, and CHG body wash twice a month.

Group Type ACTIVE_COMPARATOR

MRSA Decolonization

Intervention Type DRUG

Participants in this arm will be instructed to complete a decolonization regimen that will involve a 5-day application of nasal mupirocin, oral CHG rinse, and CHG body wash twice a month.

Education Arm

Patients randomized to standard education will receive a binder with MRSA educational materials which will include or be based upon CDC guidance for MRSA patients at home. In addition, educational material on hygiene practices to prevent MRSA infection will be provided.

Group Type ACTIVE_COMPARATOR

Standard-of-Care Education

Intervention Type BEHAVIORAL

Patients randomized to standard education will receive a binder with MRSA educational materials which will include or be based upon CDC guidance for MRSA patients at home.

Interventions

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Standard-of-Care Education

Patients randomized to standard education will receive a binder with MRSA educational materials which will include or be based upon CDC guidance for MRSA patients at home.

Intervention Type BEHAVIORAL

MRSA Decolonization

Participants in this arm will be instructed to complete a decolonization regimen that will involve a 5-day application of nasal mupirocin, oral CHG rinse, and CHG body wash twice a month.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* 1\) At least 18 years old
* 2\) Have had a positive culture (a type of test) for MRSA during recent hospital admission or within the 30 days prior to admission or following discharge
* 3\) Able to give consent or have a primary caregiver provide consent
* 4\) Able to bathe or shower or have this consistently performed by a willing caregiver

Exclusion Criteria

* 1\) Known allergies to chlorhexidine or mupirocin
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Agency for Healthcare Research and Quality (AHRQ)

FED

Sponsor Role collaborator

University of California, Irvine

OTHER

Sponsor Role lead

Responsible Party

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Susan Huang

Director of Epidemiology and Infection Prevention

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Susan S Huang, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of California, Irivne - School of Medicine

Locations

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Covington Care Center

Aliso Viejo, California, United States

Site Status

West Anaheim Extended Care

Anaheim, California, United States

Site Status

Downey Regional Medical Center

Downey, California, United States

Site Status

Fountain Valley Regional Hospital & Medical Center

Fountain Valley, California, United States

Site Status

Orange Coast Memorial Medical Center

Fountain Valley, California, United States

Site Status

St. Jude Medical Center

Fullerton, California, United States

Site Status

Chapman Care Center

Garden Grove, California, United States

Site Status

Pacific Haven HealthCare Center

Garden Grove, California, United States

Site Status

Regents Point at Windcrest

Irvine, California, United States

Site Status

Saddleback Memorial Medical Center - Laguna Hills

Laguna Hills, California, United States

Site Status

Long Beach Memorial Medical Center

Long Beach, California, United States

Site Status

St. Mary Medical Center

Long Beach, California, United States

Site Status

Mission Hospital

Mission Viejo, California, United States

Site Status

Hoag Memorial Hospital Presbyterian

Newport Beach, California, United States

Site Status

Villa Elena Health Care Center

Norwalk, California, United States

Site Status

UC Irvine Medical Center

Orange, California, United States

Site Status

Saddleback Memorial Medical Center - San Clemente

San Clemente, California, United States

Site Status

Little Company of Mary - San Pedro

San Pedro, California, United States

Site Status

Country Villa Plaza

Santa Ana, California, United States

Site Status

Royale Healthcare

Santa Ana, California, United States

Site Status

Torrance Memorial Medical Center

Torrance, California, United States

Site Status

Providence Little Company of Mary Medical Center

Torrance, California, United States

Site Status

Harbor-UCLA Medical Center

Torrence, California, United States

Site Status

Ventura County Medical Center

Ventura, California, United States

Site Status

Countries

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United States

References

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Klein E, Smith DL, Laxminarayan R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis. 2007 Dec;13(12):1840-6. doi: 10.3201/eid1312.070629.

Reference Type BACKGROUND
PMID: 18258033 (View on PubMed)

Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis. 2003 Feb 1;36(3):281-5. doi: 10.1086/345955. Epub 2003 Jan 17.

Reference Type BACKGROUND
PMID: 12539068 (View on PubMed)

Huang SS, Hinrichsen VH, Stulgis L, Miroshnik I, Datta R, Watson K, Platt R. Methicillin-resistant Staphylococcus aureus Infection in the Year Following Detection of Carriage (oral presentation). Society of Healthcare Epidemiology of America Annual Meeting (Chicago, IL), March 18-21, 2006.

Reference Type BACKGROUND

Klevens RM, Morrison MA, Nadle J, Petit S, Gershman K, Ray S, Harrison LH, Lynfield R, Dumyati G, Townes JM, Craig AS, Zell ER, Fosheim GE, McDougal LK, Carey RB, Fridkin SK; Active Bacterial Core surveillance (ABCs) MRSA Investigators. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007 Oct 17;298(15):1763-71. doi: 10.1001/jama.298.15.1763.

Reference Type BACKGROUND
PMID: 17940231 (View on PubMed)

Huang SS, Singh R, McKinnell JA, Park S, Gombosev A, Eells SJ, Gillen DL, Kim D, Rashid S, Macias-Gil R, Bolaris MA, Tjoa T, Cao C, Hong SS, Lequieu J, Cui E, Chang J, He J, Evans K, Peterson E, Simpson G, Robinson P, Choi C, Bailey CC Jr, Leo JD, Amin A, Goldmann D, Jernigan JA, Platt R, Septimus E, Weinstein RA, Hayden MK, Miller LG; Project CLEAR Trial. Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers. N Engl J Med. 2019 Feb 14;380(7):638-650. doi: 10.1056/NEJMoa1716771.

Reference Type DERIVED
PMID: 30763195 (View on PubMed)

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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2010-7710

Identifier Type: -

Identifier Source: org_study_id

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