The results, published last month in the Lancet, showed that patients with a central line catheter or lumbar drain who received the chlorhexidine bath experienced a 31% reduction in bloodstream infections and a nearly 40% reduction in antibiotic-resistant bacteria, specifically methicillin-resistant Staphylococcus aureus, or MRSA, and vancomycin-resistant enterococcus, or VRE. As part of the study, the patients with known MRSA and VRE received the nasal antibiotic mupirocin for five days in addition to the chlorhexidine bath.
No marginal difference in infection rates was seen for patients without central lines who received the bath with chlorhexidine and those who just got a soap and water bath.
Dr. Jonathan Perlin, HCA’s chief medical officer, said he wasn’t surprised by the results given that patients with such catheters or drains are more vulnerable to infections compared with other patients on medical and surgical floors.
Even though those patients accounted for only 12% of all HCA patients in the study, they made up 37% of the cases of MRSA and VRE, along with more than half of all bloodstream infection incidences.
Given these results, HCA is currently implementing the protocol across all 185 of its hospitals, Perlin said.
Last month Research Medical Center in Kansas City, Mo., was one of the latest HCA facilities to roll out the practice. Efforts began in the fall to implement the new protocol across all of the 590-bed hospital’s medical and surgical units.
HCA’s corporate headquarters sent infection prevention leaders and nurse leaders a detailed PowerPoint presentation about the practices.
The chlorhexidine soap is embedded in disposable washcloths. Six cloths are wrapped in one plastic container per patient. Each cloth is to be used on specific sections of the body. For example, one cloth cleanses the neck and arms while another is used for the legs. The cloths are used once and discarded.
After the leaders practiced how to conduct the baths, they began to inform their frontline nurses. Time was set aside for nurses to go through the PowerPoint and then to practice on each other. All 1,500 nurses at the hospital were trained.
Dr. Olevia Pitts, chief medical officer at Research Medical, said nurses implemented the new practice with relative ease. “They just added it to their workflow,” she said. “They know it’s a priority so it doesn’t get skipped.”
Perlin said the protocol is something hospitals across the country can implement. Chlorhexidine soap isn’t too costly. A 2017 study of bathing patients in chlorhexidine gluconate solutions at a small academic center found it cost $33 every other day and reduced infections, which can cost between $6,000 to $60,000 to treat per incidence.
“There is a little bit of an extra expense, but it’s a lot less expensive than a hospital-acquired infection,” Perlin said.