How HCA Healthcare cut bloodstream infections among patients with central lines, drains by 30%

A medical worker washing her hands at a sink.
A focus on handwashing in hospitals has made a big dent in infection control. But a new study found that cleaning patients with antiseptic made a big impact on hospital-acquired infection rates among patients with central lines or drains. (Getty/monkeybusinessimages)

When it comes to preventing infections in hospitals, officials may want to harness the power of a little antiseptic.

In a massive trial that took place among 330,000 patients at 53 hospitals, Nashville-based hospital giant HCA Healthcare found it could achieve a more than 30% cut in hospital-acquired bloodstream infections in the general population of patients that had central line catheters or drains. 

Published in the latest edition of the journal The Lancet, researchers reported that they achieved an approximately 40% reduction in antibiotic-resistant bacteria.

"That's a really strong signal," Jonathan Perlin, M.D., Ph.D., who is a lead author and HCA Healthcare’s president of clinical services and chief medical officer, told FierceHealthcare.

The study was conducted through a collaboration among HCA Healthcare, Harvard Pilgrim Health Care Institute, the University of California Irvine, and Rush University. There was no significant difference between the two intervention groups in the population overall, but the researchers found that those with lines and drains—the patients who most commonly develop HAIs—experienced the benefit. 

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Called the ABATE (Active Bathing to Eliminate) Infection trial, researchers studied the impact of daily bathing using cloths with the antiseptic soap chlorhexidine (as well as giving a nasal antibiotic to those patients with MRSA) compared to daily bathing with ordinary soap and water.

The trial was building off of the REDUCE MRSA Trial, published by the New England Journal of Medicine in 2013, that found similar success using the same protocol in HCA intensive care units.

"Over the last 20 years, we've changed our thinking from 'these infections are unfortunate and bad luck' to really understanding the mechanisms of infection and infection prevention through formal rigorous study," Perlin said. 

It's part of an evolution of understanding about infection control which began with focuses on handwashing among caregivers but has extended into the hygiene of the patient in recent years.

For example, Dignity Health reduced surgical site infections by providing patients with a shower card that can hang over a showerhead, an appropriate soap and a timer to ensure they cleanse their skin thoroughly prior to surgery. A Virginia VA hospital found that it could dramatically reduce its cases of pneumonia by getting patients to brush their teeth

The latest antiseptic study could be a crucial finding in the field of infection control, which is still struggling to help the industry find ways to reduce HAIs. It's estimated that 2.1 million people get HAIs and 80,000 people die from them per year.

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It also offers a scalable solution for combating infections that is less likely to worsen the development of antimicrobial resistance caused by antibiotics, Perlin said. 

"The study is an example of what large, connected health systems like HCA can do," Perlin said, noting that all the data across the hospitals that participated in the study could store their information in a central data warehouse.

Since the study was conducted under “real world” conditions at community hospitals, the results of ABATE are believed to be generally applicable to hospitals across the country.

HCA is working to roll out the protocol across the rest of its hospitals, he said. It is also testing the reduced use of the nasal antibiotic by swapping in an antiseptic that could be used instead.