ABATE Infection Trial: HCA Healthcare confronts healthcare-associated infections head-on

For more than a decade, HCA Healthcare has been a leader in the national effort to reduce healthcare-associated infections and provide a safer hospital environment for our patients.

Today, we are thrilled to share the news that a companion study to 2013’s REDUCE MRSA, known as the Active Bathing to Eliminate Infection, or ABATE, Trial, has been published in The Lancet.

While the REDUCE MRSA trial focused on ICU patients, The ABATE Infection Trial focused on patients outside the ICU. Conducted exclusively at affiliate hospitals over a 21 month period, the study identifies that a nasal infection-control technique and patient bathing with chlorhexidine drastically reduces bloodstream infections in non-ICU patients with devices by 31 percent, and reduces infection with antibiotic-resistant bacteria by 40 percent.

Non-ICU patients with devices – such as central venous catheters, midline catheters, and lumber drains – saw great benefit from the chlorhexidine bathing and nasal application of the antibiotic mupirocin.

The trial was conducted at 53 HCA Healthcare hospitals, engaging 330,000 patients in 194 non-ICU units.

“This reflects HCA Healthcare’s commitment to be a true learning healthcare system,” said Dr. Jonathan B. Perlin, 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.”

Snapshot: healthcare-associated infections (HAIs)

Nearly one in 31 hospitalized patients has contracted at least one infection, according to the Centers for Disease Control and Prevention (CDC). Healthcare-associated infections are often caused by common bacteria like vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). Normally living on the skin or in the nose, these types of pathogens can cause serious infections, like sepsis or pneumonia.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteria

”This study addresses some of the most common causes of harm in hospitals:  bloodstream infections and infections with resistant organisms,” said Dr. Kenneth Sands, HCA Healthcare’s chief epidemiologist and chief patient safety officer. “This study took advantage of the scale of HCA Healthcare to provide knowledge that in other environments would take several years to gather.”

VRE and MRSA are resistant to many antibiotics, making them difficult to treat. In a hospital setting, those who are ill or have weakened immune systems, are at greater risk for contracting the potentially life-threatening infections.

Patients with lumbar drains and catheters are also especially susceptible to infection as these devices can be an entry point for contamination.

“The results make sense because patients with devices are at greater overall risk of infection,” said Dr. Sands. “The study shows that we can successfully target prevention efforts at the more vulnerable population.   We now have a new, proven approach to help keep our patients safe.”

Dr. Kenneth Sands, HCA Healthcare’s chief epidemiologist and chief patient safety officer

Protecting patients and making healthcare safer

In 2013, 43 HCA Healthcare hospitals partook in a landmark research study, the REDUCE MRSA Trial, which documented simple steps intensive care units (ICUs) can take to dramatically reduce infections and antibiotic-resistant bacteria. MRSA clinical cultures were significantly reduced by 37 percent and bloodstream infections caused by all pathogens were decreased by 44 percent.

The infection reduction was accomplished via a simple protocol of actively “bathing” patients’

• skin with chlorhexidine (CHG) and
• nasal passages with mupirocin ointment.

The ABATE Infection trial utilized the same “bathing” protocol as the REDUCE MRSA study to combat infection and antibiotic-resistant bacteria.

Game-changer for patients with central lines and lumbar drains

In response to the ABATE Infection Trial, HCA Healthcare has begun applying the CHG and mupirocin “bathing” protocol in its hospitals. As demonstrated in the trial results, this intervention heeds significant preventable infection in patients with:

Central venous catheters (CVCs), also called central lines, employed when a physician needs to administer medication or fluids over a long period of time into a large vein in the arm or chest. CVCs stay in as long as a patient is getting treatment to avoid multiple needle sticks for therapy. They can also be used to take out blood for testing. Patients might need a CVC if they require:

• Kidney dialysis
• Chemotherapy
• Long-term antibiotics
• Frequent blood tests

Midline catheters, usually put into the arm and can be typically used for two to four weeks to give non-irritating medication or fluid.

Lumbar drains, small, flexible tubes that are placed in the lumbar spine in patients requiring cerebrospinal fluid drainage.

The ABATE Infection trial is part of a national strategy to reduce HAIs. The study was conducted through a longstanding collaboration amongst 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.

The study, conducted in “real-world” conditions across community hospitals nationwide, demonstrates the reach of the healthcare field’s largest system for analyzing clinical data. Believing in the power of our learning health system, we will continue to fight for and find effective ways to protect our patients from infection.

HCA Healthcare has conducted a number of clinical studies, including one that demonstrated that full-term delivery is healthier than early elective delivery of babies and another that identified a clinical protocol that can reduce bloodstream infections in ICU patients by 44 percent. HCA Healthcare is a learning healthcare system that uses its more than 31 million annual patient encounters in 20 states and the United Kingdom to improve patient care and save lives.