A randomized controlled trial of tea tree oil (5%) body wash versus standard body wash to prevent colonization with methicillin-resistant Staphylococcus aureus (MRSA) in critically ill adults: research protocol

Background
Over the past ten years MRSA has become endemic in hospitals and is associated with increased healthcare costs. Critically ill patients are most at risk, in part because of the number of invasive therapies that they require in the intensive care unit (ICU). Washing with 5% tea tree oil (TTO) has been shown to be effective in removing MRSA on the skin. However, to date, no trials have evaluated the potential of TTO body wash to prevent MRSA colonization or infection. In addition, detecting MRSA by usual culture methods is slow. A faster method using a PCR assay has been developed in the laboratory, but requires evaluation in a large number of patients.

Methods/Design
This study protocol describes the design of a multicentre, phase II/III prospective open-label randomized controlled clinical trial to evaluate whether a concentration of 5% TTO is effective in preventing MRSA colonization in comparison with a standard body wash (Johnsons Baby Softwash) in the ICU. In addition we will evaluate the cost-effectiveness of TTO body wash and assess the effectiveness of the PCR assay in detecting MRSA in critically ill patients. On admission to intensive care, swabs from the nose and groin will be taken to screen for MRSA as per current practice. Patients will be randomly assigned to be washed with the standard body wash or TTO body wash. On discharge from the unit, swabs will be taken again to identify whether there is a difference in MRSA colonization between the two groups.

Discussion
If TTO body wash is found to be effective, widespread implementation of such a simple colonization prevention tool has the potential to impact on patient outcomes, healthcare resource use and patient confidence both nationally and internationally.

Trial Registration
[ISRCTN65190967]

The Diminishing Returns to Trade Policy in the European Union

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The Nineteenth Century Law of the Sea and the British Abolition of the Slave Trade

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Placing political economy: organising opposition to free trade before the abolition of the Corn Laws

The unfurling of global capitalism – and its attendant effects – has long been fertile intellectual terrain for geographers. But whilst studies of the processes and mechanisms of globalisation undoubtedly assume a talismanic importance in the discipline, geographers, with few exceptions, have left examinations of early economic liberalism to historians. One such critically important episode in the evolution of the liberal economic project was the repeal of the so-called 'Corn Laws' in 1846. Whilst the precise impact of the Manchester-based Anti-Corn Law League (ACLL) continues to be a matter of conjecture, Eric Sheppard has asserted that their particular take on political economy managed to assume a 'truth-like status' and worldwide universality. But the ACLL's campaign represents only one, albeit decisive, stage in the long intellectual and practical struggle between 'protectionists' and the disciples of free trade. Studies of the non-'Manchester' components have tended to focus squarely upon national politics. This paper examines a pivotal attempt in 1838 by Lord Melbourne's Government to experiment with the effective elimination of import duties on fresh fruit. Unlike most agricultural commodities, table fruit was produced in a tightly defined area, thus allowing the Government's experiment to play out, in theory, without national political fallout. Whilst the Government's clandestine actions left little time for a concerted opposition to develop, Kentish fruit growers soon organised. A formidable lobby was forged that drew wide local support yet also evolved beyond the original 'epistemic community'. Whilst the coalition failed in their efforts to reintroduce protective duties, their actions allow us to see how protectionist ideologies and policies were vivified through practices at many different spatial scales and to better understand the complex spatiality of protectionist takes on political economy. Their campaign also changed – at least in the short term – the course of British mercantile policy.

Nonmarket Capabilities and the Prosecution of Trade Remedy Cases in the United States

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Solving exchange rate puzzles with neither sticky prices nor trade costs

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