1 minute scrub the hub

MunoRN, RN · Jun 14, 2015

That's pretty a stupid idea based on what we know about this. There was once a push to encourage a 30 second scrub (despite the lack of evidence to support this) with the idea that if the rule was 30 seconds, then that would help ensure that people scrubbed for at least 10-15 seconds (the actual amount of time supported by evidence), but that backfired; it turned out based on internal audits that the amount of actual scrubbing that happened actually decreased when the recommended duration was excessive and worst of all the number of times where a hub was not scrubbed at all went up drastically in many facilities that openly shared their audit data. So if the overall effect of requiring a 30 second scrub duration causes harm without any apparent benefit, extending that out to 1 minute would only seem to do more of the same.

nrsang97, BSN, RN · Jun 14, 2015

Our facility had a 15 second scrub the hub policy. One minute isn't going to happen if they wont scrub for 30 seconds.

Our facility is considering the curos caps. Maybe that is also an option. Auditing dressing changes for being done within policy and going over proper technique woulx help too.

NicuGal, MSN, RN · Jun 14, 2015

We 15sec scrub, let dry for 15 sec, hang med (we have dedicated med lines so they are always flushed), scrub, dry, hang flush, wipe after.

We we found a lot of issues with line changes when we did a blind audit. And our NPs do all our line changes.

Re-education is a big player.

Editorial Team / Admin · Jun 15, 2015

Why not look into the Curos caps? My facility uses these with darn near 100% compliance, and the need to scrub the hub for any length of time is gone. Compared to the costs of infections and the low rates of compliance with scrub the hub for 15 seconds, it's worth the investment. We have them in both long strips that are hung on the IV poles for ease of replacement as well as single ones primarily in procedural areas.

Okami_CCRN, BSN, RN · Jun 15, 2015

We use PDI Prevantics which has a 5 second scrub time with a 5 second dry time. Our compliance is very high since switching to this product.

Libby1987 · Jun 15, 2015

I haven't had a patient come home without port covers in several years, and every infusion company now provides them. (Northern California) I thought everyone used those now.

NicuGal, MSN, RN · Jun 15, 2015

Our PICU used them and

then had a spike in the line infections. They found on blind audits that people had a false sense of security and weren't cleaning hubs in between hanging multiple meds/changing syringes. I don't get people. I am on my practice committee and pushing for us to get them.

Been there,done that, ASN, RN · Jun 15, 2015

Where is the drying time? That's the period where the organisms die.

sistrmoon, BSN, RN · Jun 15, 2015

Our facility had a 15 second scrub the hub policy. One minute isn't going to happen if they wont scrub for 30 seconds.
Our facility is considering the curos caps. Maybe that is also an option. Auditing dressing changes for being done within policy and going over proper technique woulx help too.

I've suggested the caps and it's a no go. They are single use and expensive. More expensive than CLABIs? Good question.

We do central dressing changes often on my floor and always have two RNs present to ensure technique. But a team with a systematic approach and schedule seems to be key from what I've read on the subject.

sistrmoon, BSN, RN · Jun 15, 2015

That's pretty a stupid idea based on what we know about this. There was once a push to encourage a 30 second scrub (despite the lack of evidence to support this) with the idea that if the rule was 30 seconds, then that would help ensure that people scrubbed for at least 10-15 seconds (the actual amount of time supported by evidence), but that backfired; it turned out based on internal audits that the amount of actual scrubbing that happened actually decreased when the recommended duration was excessive and worst of all the number of times where a hub was not scrubbed at all went up drastically in many facilities that openly shared their audit data. So if the overall effect of requiring a 30 second scrub duration causes harm without any apparent benefit, extending that out to 1 minute would only seem to do more of the same.

This makes sense to me. You don't happen to have a source for this, do you? I'd love to pass it along.

IVRUS, BSN, RN · Jun 15, 2015

That's pretty a stupid idea based on what we know about this. There was once a push to encourage a 30 second scrub (despite the lack of evidence to support this) with the idea that if the rule was 30 seconds, then that would help ensure that people scrubbed for at least 10-15 seconds (the actual amount of time supported by evidence), but that backfired; it turned out based on internal audits that the amount of actual scrubbing that happened actually decreased when the recommended duration was excessive and worst of all the number of times where a hub was not scrubbed at all went up drastically in many facilities that openly shared their audit data. So if the overall effect of requiring a 30 second scrub duration causes harm without any apparent benefit, extending that out to 1 minute would only seem to do more of the same.

If the nurses choose not to even scrub 15 seconds, because they think the recommendation of 60 seconds is too long, then these are nurses which need disciplinary action. You say that the recommendations backfired...No, you have nurses who are putting their patients in jeopardy. And though there isn't enough studies to show which actual time frame works best, there are studies which show a significant decrease in bacteria with a 15 second scrub and a 30 second scrub.