"Scrub the Hub" means... ?

[Dialysis R.N. in IA]

After 2 years working in an ICU, I have just changed to a job in an outpatient dialysis center.

The care provided to the central lines in this center is very different from what I learned in the ICU...

"Scrub the Hub" is a huge campaign against CVC infections and the like, so could anyone answer me this...?

The "hub" is... the cap on the end of the line (which is what they scrub at the dialysis center) or the portion of the end that interlocks with syringes and the like that is covered by the cap on the end of the line (which is the portion that I maintain is the "hub" which needs scrubbed!)

Any input greatly appreciated!!!

[Altra, BSN, RN]

I completely agree, scrub the hub means disinfect the (generic term) access point at which the syringe is going to access the line. I don't see what disinfection of the outside of the plastic cap accomplishes.

[Lacie, BSN, RN]

We always put a betadine or chlorahexadrine soak around the hub WITH cap on and soak for 3-5 min before removing the caps. Then scrub the hub then attach our syringes for removal of the heparin dwell from the ports before flushing for treatment start. We also be sure to do the same at treatment end before flushing and applying our syringes prior to heparin dwells. I'm not sure about other dialysis clinics but this was our standard procedure. Remember these are usually perm caths also and alcohol will break these down so it is not advised to use alcohol. Unlike temp cvc's they cant be replaced as frequently and have smaller choice of placement for long term and the pt's life line if they dont have a mature fistula or graft yet. Some pts may never have anything but a permacath as thier only access so must be protected as they are usually long term placement.

[iluvivt, BSN, RN]

Scrubbing or disinfecting caps an injection ports is not new..it is just that many in healthcare have become lazy and often we do not take action unless we are forced to. Approximately 65 % of catheter related bloodstream infections (CRBSI) come from the skin and approximately 30 % come from the cap/hub and the rest approximately 5 % come from hematogenous seeding from a distant infection or contaminated infusate. So how frustrating for clinicians who perform maximum barrier precautions during insertion and then a nurse or MD comes along and does not scrub the hub.....I have seen it happen again and again..I am sad to say. Also remember to wash your hands as well before the cap scrub. I agree with the scrub to include the entire surface that will come in contact with the syringe and if it is too soiled to clean.....it should be changed

[XingtheBBB, BSN, RN]

The OP is in dialysis so there shouldn't be any type of "posiflush" or "heplock" cap device on the end of the dialysis line. Open end to open end is the way to work there.

I remember years ago, the practice of scrubbing the outer part of the cap before opening it (breaking the system) I don't think this was ever evidence based but rather tradition (from the days when everything was super scrubbed before and after) We still wiped the inside although technically that should already be sterile. If they are scrubbing the outside cap, I'd like to know why. Is this still preferred practice? Are there current studies recommending it? I wouldn't be shocked if there are. We used to scrub the outside of foleys before opening them to change to leg bags and we scrubbed the outside of JP bulbs before opening them to empty (I still do) is that still taught?

Remember, with the one way valve caps- scrub the grooved luer part the syringe screws to as well as the center soft rubbery part that the male end pushes through. That diaphragm is the most important part and it's easy to glide over it too quickly.

[Lacie, BSN, RN]

It's standard practice and CMS guidelines to "soak" the hub for 3-5 min prior to taking the cap off for further prep for dialysis then scrub the grooves of the tip prior to putting on your syringes to remove your heparin dwells. These are caps and not lurlocks or hep locks. Just twist on caps. The dialysis lines go directly to the hubs. Also require gloves, mask and goggles/eye protection during same. If surveyor comes in and is monitoring you best be soaking them first and using ALL the proper PPE. Remember Dialysis pts and enviroment is different besides these pts are immunocompromised due to the ESRD to start with. Protocol is a little different then hospital (non-dialysis) enviroment. I had one PCT who caused us to get cited as she didnt allow the soak on for the required time and used mask but no eye protection. Surveyor literally stood back and timed with her watch during observation for inspection. I was not a happy DON with the absence of something so simple they do everyday to be cited over because it wasnt done per protocol. Best to check your companies policy and procedure as it will be procedurally documented as also required by CMS guidelines for Infection control and dialysis initiation for CVC's.

http://www.kidney.org/Professionals/kdoqi/guidelines_updates/doqiupva_iii.html