Research news

A study published in the current issue of The Lancet and conducted exclusively at HCA Healthcare hospitals has shown an infection control technique achieved a 31 percent reduction in bloodstream infections and nearly a 40 percent reduction in antibiotic-resistant bacteria among non-ICU patients with central line catheters and lumbar drains.

As a result of the study, HCA Healthcare has begun implementing the infection prevention protocol in its hospitals.

“This reflects HCA Healthcare’s commitment to be a true learning healthcare system,” said Jonathan B. Perlin, MD, HCA Healthcare’s president, clinical services, and chief medical officer and one of the study’s authors. “We use the knowledge we capture from delivering care to millions of patients a year for continuous improvement and innovation, not only to fuel our own quality improvement efforts but also to solve vexing societal challenges such as infection prevention.”

Healthcare-associated infections (HAIs) such as methicillin-resistant Staphylococcus aureus (MRSA) are a serious patient safety issue and their elimination is a top priority for the U.S. Department of Health and Human Services (HHS). On any given day, about one in 31 hospital patients has at least one HAI, according to the Centers for Disease Control and Prevention.

The study, known as the ABATE Infection (active bathing to eliminate infection) Trial, is part of a national strategy to reduce HAIs. The study was conducted through a longstanding collaboration among HCA Healthcare, Harvard Pilgrim Health Care Institute, the University of California Irvine, and Rush University. The ABATE Trial was funded by the National Institutes of Health with contributed effort from HCA Healthcare. ABATE was conducted at 53 HCA Healthcare hospitals during a 21-month period involving 330,000 patients. Because it was a large-scale, pragmatic trial—a study conducted under “real world” conditions at community hospitals—the results of ABATE are believed to be generally applicable to hospitals across the country.

A learning health system, which uses data from approximately 31 million annual patient encounters to help continuously improve care, HCA Healthcare maintains the healthcare field’s largest system for analyzing clinical data. This makes HCA Healthcare desirable for conducting “pragmatic trials” such as ABATE because the patients are cared for in a single system whose diversity reflects community hospitals across the country and whose data management system facilitates large scale analysis.

“The ABATE Infection Trial was made possible by the remarkable infrastructure of HCA Healthcare to conduct pragmatic clinical trials to impact patient care,” said Susan Huang, MD MPH, professor in the division of infectious diseases at the University of California, Irvine School of Medicine. “Here, we found that by implementing specific antiseptic protocols, we could prevent serious infections in patients with medical devices.”

The ABATE Infection Trial builds on the REDUCE MRSA Trial research conducted at HCA Healthcare hospitals and published by the New England Journal of Medicine in 2013 that documented how intensive care units in HCA Healthcare hospitals dramatically reduced infections and antibiotic resistant bacteria. Conducted among non-ICU patients, the ABATE Trial evaluated whether daily bathing with the antiseptic soap chlorhexidine (CHG)—and in those patients with MRSA, adding the nasal antibiotic mupirocin—more effectively reduced hospital-acquired bacterial infections than bathing with ordinary soap and water. While no significant difference between the two intervention groups was seen within the population overall, the researchers did find that patients with medical devices experienced a substantial benefit if they received the CHG/mupirocin intervention. Compared to patients outside the intervention, they experienced a 31 percent decrease in bloodstream infections and a nearly 40 percent decrease in antibiotic resistant organisms, specifically MRSA and vancomycin-resistant enterococcus (VRE).

Although only 12 percent of patients in the study had central lines and lumbar drains, because these devices can be an entry point for infections, patients with them accounted for 37 percent of MRSA and VRE clinical cultures and more than half of all bloodstream infections.

The antiseptic product was contributed by Sage Products and MoInlycke. The companies providing product to the trial had no role in the design, conduct, analysis or publication of the ABATE Infection Trial.


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