The Comparative Efficacy of Tea Tree Oil Body Wash versus Chlorhex-idine Body Wash to Prevent Colonization with Methicillin-Resistant Staphylococcus Aureus in a Pediatric Unit
,
Abstract
Background: Methicillin-resistant Staphylococcus Aureus (MRSA) stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics. Non-intact skin, such as when there are abrasions or incisions, is often the site of an MRSA infection. MRSA has become endemic in hospitals over the past years. The current recommendation for MRSA decolonization is to use a daily chlorohexidine skin wash for five days. Tea Tree Oil (TTO) can also be considered for the eradication of MRSA on the skin. However, no study has evaluated the TTO potential for MRSA decolonization in hospitalized children. Methods:In this single-center, comparative prospective, open-label clinical trial, the effect of TTO body wash on MRSA decolonization was compared to that of chlorhexidine body wash at Loghman-e-Hakim Hospital (Tehran, Iran). Several samples were taken from the catheter sites of children for MRSA detection. Patients were assigned to receive either TTO or chlorhexidine. After five days of applying the solutions, resampling was conducted to assess the colonization of MRSA. Results: Both TTO and chlorhexidine groups showed favorable results for MRSA decolonization. From 382 patients, 91 were MRSA-positive (about 23.82%), and of these 91 patients, 41 (45%) were female and 59 (55%) were male. The mean ± SD of the growth inhibition zone against MRSA was 19.20 ± 3.73 and 33.41 ± 9.53 for chlorhexidine and TTO, respectively. Conclusion: TTO body wash proved to be more effective than chlorhexidine in MRSA decolonization in hospitalized children. Implementation of such decolonization can improve patients’ outcomes and prevent MRSA transmission.
1. Raman A, Weir U, Bloomfield SF. Antimicrobial effects of tea-tree oil and its major components on Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes. Lett Appl.Microbiol. 1995;21:242–5.
2. Caelli M, Porteous J, Carson CF, Heller R, Riley TV. Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2000;46:236–7.
3. Williams LR, Home VN, Lusunzi I. An evaluation of the contribution of cineole and ter-pinen-4-ol to the overall antimicrobial activity of tea tree oil. Cosmet Aerosols Toilet Aust. 1993;7:25–34.
4. Labordus-van Helvoirt REM, van Rijen MML, van Wijngaarden P. Tonsillectomy for persistent MRSA carriage in the throat-Description of three cases. Int J Infect Dis. 2017; 67: 98–101.
5. Carson CF, Cookson BD, Farrelly HD, Riley TV. Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Melaleuca alternifolia. J Antimicrob Chemother. 1995; 35:421–4.
6. Banes-Marshall L, Cawley P, Phillips CA. In vitro activity of Melaleuca alternifolia (tea tree) oil against bacterial and Candida spp. Isolates from clinical specimens. Br J Biomed Sci. 2001;58:139–45.
7. International Organisation for Standardisation. ISO 4730:2004. In Oil of Melaleuca, Ter-pinen-4-ol Type (Tea Tree Oil); International Organisation for Standardisation: Geneva, Switzerland, 2004.
8. Homer LE, Leach DN, Lea D, Lee LS, Henry RJ, Baverstock PR. Natural variation in the essential oil content of Melaleuca alternifolia Cheel (Myrtaceae). Biochem Syst Ecol 2000; 28:367–82.
9. Christoph F, Kaulfers PM, Stahl-Biskup E. A comparative study of the in vitro antimi-crobial activity of tea tree oils s.l. with special reference to the activity of triketones. Planta Med. 2000;66:556–60.
10. Bassette IN, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne. Med J AUS. 1990;153:445–8.
11. Enshaie S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical Tea Tree Oil gel in mild to moderate acne vulgaris: A randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73:22–25.
12. Loughlin R, Glimore B, McCarron PA, Tunney MM. Comparison of the cidal activity of Tea Tree Oil and terpinen-4-ol against clinical bacterial skin and human fibroblast cells. Lett Appl Microbiol. 2008;46:428–33.
13. Karpanen TJ, Worthington T, Hendry ER, Conway BR, Lambert PA. Antimicrobial ef-ficacy of chlorhexidine digluconate alone and incombination with eucalyptus oil, tea tree oil and thymol against, planktonic and biofilm cultures of staphylococcus epidermidis. J Antimicrob Chemother. 2008;62:1031–6.
14. Penfold AR, Grant R. The germicidal values of some Australian essential oils and their pure constituents, together with those for some essential oil isolates, and synthetics. Part III J R Soc New South Wales. 1925;59:346–9.
15. Penfold AR, Morrison FR. Bulletin No. 14. In Australian Tea Trees of Economic Value, Part 1, 3rd ed.; Thomas Henry Tennant, Government Printer: Sydney, Australia, 1946.
16. Blackwell R. An insight into aromatic oils: Lavender and tea tree. Br J Phytother. 1991;2: 26–30.
17. Del Beccaro MA. Melaleuca Oil Poisoning in a 17-month-old. Vet Hum Toxicol. 1995; 37:557–8.
18. Lassak EV, McCarthy T. Australian Medicinal Plants; Methuen Australia: North Ryde, Australia, 1983; Volume 115, pp. 93–99.
19. Raman A, Weir U, Bloomfield SF. Antimicrobial effects of tea-tree oil and its major components on Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes. Lett Appl Microbiol. 1995;21:242–5.
20. Walsh LJ, Longstaff J. The antimicrobial effects of an essential oil on selected oral path-ogens. Periodontology. 1987;8:11–15.
21. Williams LR, Home VN. Plantation production of oil of melaleuca (tea tree oil)-A revi-talised Australian essential oil industry. Search. 1988;19:294–7.
22. Carson CF, Riley TV. Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia. J Appl Bacteriol. 1995;78:264–9.
23. Jawetz E, Melnick GL, Adelberg EA. Medical, Microbiology, 24th ed.; Mc Graw Hill Inc.: Columbus, OH, USA, 2007; pp. 224–230.
24. Cho OH, Park KH, Song JY, et al. Prevalence and microbiological characteristics of qac/B-positive methicillin-resistant staphylococcus aureus isolates in a surgical intensive care unit. Microb. Drug Resist. 2017;24:283–9.
25. Pratt RJ, Pellowe CM, Wilson JA, et al. epic2: National evidencebased guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007; 65 (Suppl. 1): S1–S64.
26. O'grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascu-lar catheter-related infections. MMWR Recomm Rep. 2002;51:1–29.
27. Carson CF, Hammer KA, Riley TV. Broth micro-dilution method for determining the susceptibility of Escherichia coli and Staphylococcus aureus to the essential oil of Mela-leuca alternifolia (tea tree oil). Microbios. 1995;82:181–5.
28. Parki H, Jang CH, Cho YB, Cho CH. Antibacterial effect of Tea Tree Oil on methicillin resistant staphylococcus aureus biofilm formation of the Tympanostomy tube; an in vitro study. In Vivo. 2007;21:1027–30.
29. Peterson LR, Woods CW, Davis TE, et al. Performance of the cobas MRSA/SA Test for Simultaneous Detection of Methicillin-Susceptible and Methicillin-Resistant Staphylo-coccus aureus From Nasal Swabs. Am J Clin Pathol. 2017;148:119–27.
30. Mann CM, Markham JL. A new method for determining the minimum inhibitory concen-tration of essential oils. J Appl Microbiol. 1998;84:538–44.
31. Tiewsoh JBA, Dias M. Screening of methicillin-resistant Staphylococcus aureus in healthcare workers and students and its susceptibility to mupirocin in a tertiary care teaching hospital in South India. J Lab Physicians. 2017;9:239–42.
32. Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: Clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother. 2015; 70:2681–92.
33. Nelson RRS. In-vitro activities of five plant essential oils against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother. 1997;40:305–6.
34. Dryden,MS, Daily S, Crouch M. A randomized, controlled trial of tea tree topical prepa-ration versus a standard topical regimen for the clearance of MRSA colonization. J Hosp Infect. 2004;56:283–6.
35. Flaxman D, Griffiths P. Is tea tree oil effective at eradicating MRSA colonization? A re-view. Br J Community Nurs. 2005;10:123–6.
36. McMahon MA, Tunney M.M, Moore JE, Blair IS, Gilpin DF, McDowell DA. Changes in antibiotic susceptibility in staphylococci habituated to sub-lethal concentrations of tea tree oil (Melaleuca alternifolia). Lett Appl Microbiol. 2008;47:263–8.
37. McConeghy KW, Micholich DJ, LaPlante KL. Agents for the decolonization of methicil-lin-resistant Staphylicoccus aureus. Pharmacotherapy. 2009;29:263–80.
38. Edmondson M, Newall N, Carville K, Smith J, Riley TV, Carson CF. Uncontrolled, open-label, pilot study of tea tree (Melaleuca alternifolia) oil solution in the decoloniza-tion of methicillin-resistant Staphylococcus aureus positive wounds and its influence on wound healing. Int Wound J. 2011;8:375–84.
39. Blackwood B, Thompson G, McMullan R, et al. Tea tree oil (5%) body wash versus standard care (Johnson's Baby Softwash) to prevent colonization with methicil-lin-resistant Staphylococcus aureus in critically ill adults: A randomized controlled trial. J Antimicrob Chemother. 2013:68:1193–9.
40. Thompson G, Blackwood B, McMullan R, et al. A randomized controlled trial of tea tree oil (5%) body wash versus standard body wash to prevent colonization with methicil-lin-resistant Staphylococcus aureus (MRSA) in critically ill adults: Research protocol. BMC Infect Dis. 2008;8:161.
41. Moyo SJ, Nkinda L, Majigo M, et al. Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Sa-laam, Tanzania. BMC Res Notes. 2017;10:417.
42. Henderson A, Nimmo GR. Control of healthcare- and community-associated MRSA: Recent progress and persisting challenges. Br Med Bull. 2017;125:25–41.
43. Falci SPP, Teixeira MA, Chagas PFD, et al. Antimicrobial activity of Melaleuca sp. oil against clinical isolates of antibiotics resistant Staphylococcus aureus. Acta Cir Bras. 2015;30:401–6.
2. Caelli M, Porteous J, Carson CF, Heller R, Riley TV. Tea tree oil as an alternative topical decolonization agent for methicillin-resistant Staphylococcus aureus. J Hosp Infect. 2000;46:236–7.
3. Williams LR, Home VN, Lusunzi I. An evaluation of the contribution of cineole and ter-pinen-4-ol to the overall antimicrobial activity of tea tree oil. Cosmet Aerosols Toilet Aust. 1993;7:25–34.
4. Labordus-van Helvoirt REM, van Rijen MML, van Wijngaarden P. Tonsillectomy for persistent MRSA carriage in the throat-Description of three cases. Int J Infect Dis. 2017; 67: 98–101.
5. Carson CF, Cookson BD, Farrelly HD, Riley TV. Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Melaleuca alternifolia. J Antimicrob Chemother. 1995; 35:421–4.
6. Banes-Marshall L, Cawley P, Phillips CA. In vitro activity of Melaleuca alternifolia (tea tree) oil against bacterial and Candida spp. Isolates from clinical specimens. Br J Biomed Sci. 2001;58:139–45.
7. International Organisation for Standardisation. ISO 4730:2004. In Oil of Melaleuca, Ter-pinen-4-ol Type (Tea Tree Oil); International Organisation for Standardisation: Geneva, Switzerland, 2004.
8. Homer LE, Leach DN, Lea D, Lee LS, Henry RJ, Baverstock PR. Natural variation in the essential oil content of Melaleuca alternifolia Cheel (Myrtaceae). Biochem Syst Ecol 2000; 28:367–82.
9. Christoph F, Kaulfers PM, Stahl-Biskup E. A comparative study of the in vitro antimi-crobial activity of tea tree oils s.l. with special reference to the activity of triketones. Planta Med. 2000;66:556–60.
10. Bassette IN, Pannowitz DL, Barnetson RS. A comparative study of tea-tree oil versus benzoyl peroxide in the treatment of acne. Med J AUS. 1990;153:445–8.
11. Enshaie S, Jooya A, Siadat AH, Iraji F. The efficacy of 5% topical Tea Tree Oil gel in mild to moderate acne vulgaris: A randomized, double-blind placebo-controlled study. Indian J Dermatol Venereol Leprol. 2007;73:22–25.
12. Loughlin R, Glimore B, McCarron PA, Tunney MM. Comparison of the cidal activity of Tea Tree Oil and terpinen-4-ol against clinical bacterial skin and human fibroblast cells. Lett Appl Microbiol. 2008;46:428–33.
13. Karpanen TJ, Worthington T, Hendry ER, Conway BR, Lambert PA. Antimicrobial ef-ficacy of chlorhexidine digluconate alone and incombination with eucalyptus oil, tea tree oil and thymol against, planktonic and biofilm cultures of staphylococcus epidermidis. J Antimicrob Chemother. 2008;62:1031–6.
14. Penfold AR, Grant R. The germicidal values of some Australian essential oils and their pure constituents, together with those for some essential oil isolates, and synthetics. Part III J R Soc New South Wales. 1925;59:346–9.
15. Penfold AR, Morrison FR. Bulletin No. 14. In Australian Tea Trees of Economic Value, Part 1, 3rd ed.; Thomas Henry Tennant, Government Printer: Sydney, Australia, 1946.
16. Blackwell R. An insight into aromatic oils: Lavender and tea tree. Br J Phytother. 1991;2: 26–30.
17. Del Beccaro MA. Melaleuca Oil Poisoning in a 17-month-old. Vet Hum Toxicol. 1995; 37:557–8.
18. Lassak EV, McCarthy T. Australian Medicinal Plants; Methuen Australia: North Ryde, Australia, 1983; Volume 115, pp. 93–99.
19. Raman A, Weir U, Bloomfield SF. Antimicrobial effects of tea-tree oil and its major components on Staphylococcus aureus, Staph. epidermidis and Propionibacterium acnes. Lett Appl Microbiol. 1995;21:242–5.
20. Walsh LJ, Longstaff J. The antimicrobial effects of an essential oil on selected oral path-ogens. Periodontology. 1987;8:11–15.
21. Williams LR, Home VN. Plantation production of oil of melaleuca (tea tree oil)-A revi-talised Australian essential oil industry. Search. 1988;19:294–7.
22. Carson CF, Riley TV. Antimicrobial activity of the major components of the essential oil of Melaleuca alternifolia. J Appl Bacteriol. 1995;78:264–9.
23. Jawetz E, Melnick GL, Adelberg EA. Medical, Microbiology, 24th ed.; Mc Graw Hill Inc.: Columbus, OH, USA, 2007; pp. 224–230.
24. Cho OH, Park KH, Song JY, et al. Prevalence and microbiological characteristics of qac/B-positive methicillin-resistant staphylococcus aureus isolates in a surgical intensive care unit. Microb. Drug Resist. 2017;24:283–9.
25. Pratt RJ, Pellowe CM, Wilson JA, et al. epic2: National evidencebased guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect. 2007; 65 (Suppl. 1): S1–S64.
26. O'grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascu-lar catheter-related infections. MMWR Recomm Rep. 2002;51:1–29.
27. Carson CF, Hammer KA, Riley TV. Broth micro-dilution method for determining the susceptibility of Escherichia coli and Staphylococcus aureus to the essential oil of Mela-leuca alternifolia (tea tree oil). Microbios. 1995;82:181–5.
28. Parki H, Jang CH, Cho YB, Cho CH. Antibacterial effect of Tea Tree Oil on methicillin resistant staphylococcus aureus biofilm formation of the Tympanostomy tube; an in vitro study. In Vivo. 2007;21:1027–30.
29. Peterson LR, Woods CW, Davis TE, et al. Performance of the cobas MRSA/SA Test for Simultaneous Detection of Methicillin-Susceptible and Methicillin-Resistant Staphylo-coccus aureus From Nasal Swabs. Am J Clin Pathol. 2017;148:119–27.
30. Mann CM, Markham JL. A new method for determining the minimum inhibitory concen-tration of essential oils. J Appl Microbiol. 1998;84:538–44.
31. Tiewsoh JBA, Dias M. Screening of methicillin-resistant Staphylococcus aureus in healthcare workers and students and its susceptibility to mupirocin in a tertiary care teaching hospital in South India. J Lab Physicians. 2017;9:239–42.
32. Poovelikunnel T, Gethin G, Humphreys H. Mupirocin resistance: Clinical implications and potential alternatives for the eradication of MRSA. J Antimicrob Chemother. 2015; 70:2681–92.
33. Nelson RRS. In-vitro activities of five plant essential oils against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium. J Antimicrob Chemother. 1997;40:305–6.
34. Dryden,MS, Daily S, Crouch M. A randomized, controlled trial of tea tree topical prepa-ration versus a standard topical regimen for the clearance of MRSA colonization. J Hosp Infect. 2004;56:283–6.
35. Flaxman D, Griffiths P. Is tea tree oil effective at eradicating MRSA colonization? A re-view. Br J Community Nurs. 2005;10:123–6.
36. McMahon MA, Tunney M.M, Moore JE, Blair IS, Gilpin DF, McDowell DA. Changes in antibiotic susceptibility in staphylococci habituated to sub-lethal concentrations of tea tree oil (Melaleuca alternifolia). Lett Appl Microbiol. 2008;47:263–8.
37. McConeghy KW, Micholich DJ, LaPlante KL. Agents for the decolonization of methicil-lin-resistant Staphylicoccus aureus. Pharmacotherapy. 2009;29:263–80.
38. Edmondson M, Newall N, Carville K, Smith J, Riley TV, Carson CF. Uncontrolled, open-label, pilot study of tea tree (Melaleuca alternifolia) oil solution in the decoloniza-tion of methicillin-resistant Staphylococcus aureus positive wounds and its influence on wound healing. Int Wound J. 2011;8:375–84.
39. Blackwood B, Thompson G, McMullan R, et al. Tea tree oil (5%) body wash versus standard care (Johnson's Baby Softwash) to prevent colonization with methicil-lin-resistant Staphylococcus aureus in critically ill adults: A randomized controlled trial. J Antimicrob Chemother. 2013:68:1193–9.
40. Thompson G, Blackwood B, McMullan R, et al. A randomized controlled trial of tea tree oil (5%) body wash versus standard body wash to prevent colonization with methicil-lin-resistant Staphylococcus aureus (MRSA) in critically ill adults: Research protocol. BMC Infect Dis. 2008;8:161.
41. Moyo SJ, Nkinda L, Majigo M, et al. Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Sa-laam, Tanzania. BMC Res Notes. 2017;10:417.
42. Henderson A, Nimmo GR. Control of healthcare- and community-associated MRSA: Recent progress and persisting challenges. Br Med Bull. 2017;125:25–41.
43. Falci SPP, Teixeira MA, Chagas PFD, et al. Antimicrobial activity of Melaleuca sp. oil against clinical isolates of antibiotics resistant Staphylococcus aureus. Acta Cir Bras. 2015;30:401–6.
| Files | ||
| Issue | Vol 11, No 2 (Spring 2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v11i2.13362 | |
| Keywords | ||
| Tea Tree Oil; Hospital-Acquired Infection; Chlorhexidine; Methicillin-Resistant Staphylococ-cus aureus | ||
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How to Cite
1.
Rahbari S, Rajabi M, Pournasiri Z. The Comparative Efficacy of Tea Tree Oil Body Wash versus Chlorhex-idine Body Wash to Prevent Colonization with Methicillin-Resistant Staphylococcus Aureus in a Pediatric Unit. J Pharm Care. 2023;11(2):74-81.
