Curious if you all are still using 15sec for your Scrub the Hub policy? We are talking about decreasing it but it makes me nervous that nurses will not scrub at all. Thoughts?
I share your concerns. Did you realize there is no definitive clinical evidence to support any specific scrub time. A recent systematic literature review stated when scrubbing with alcohol, the range is 5 to 60 seconds in the literature. Use of alcoholic CHG might be different but that has not been established either. The resource your hospital is probably hearing from is the manufacturer of the brand of needleless connector in use. You will need to obtain, read, and analyze the supporting evidence they share with you. Finally, I don't think we will ever really be able to manually scrub any needleless connector to render it safe for use. I think passive disinfection caps are necessary. We have very good clinical evidence about CLABSI reduction from published studies on these caps.
An article by Curran (2016, Jnl of Infection Prevention) refers to Epic3 (IVAD30) recommendation for a 15 second scrub. However, the evidence is non-analytic studies and expert opinion, so the evidence is weak. Curran supported the 15 sec recommendation, in part, because a longer scrub time is needed to disinfect for "heavy contamination." Since one cannot ascertain at the bedside which needleless connector has "heavy contaminiation," she recommends 15 sec scrub with antiseptic drying. (Epic 3 are UK NHS guidelines for preventing HAI.)
I share your concerns. Did you realize there is no definitive clinical evidence to support any specific scrub time. A recent systematic literature review stated when scrubbing with alcohol, the range is 5 to 60 seconds in the literature. Use of alcoholic CHG might be different but that has not been established either. The resource your hospital is probably hearing from is the manufacturer of the brand of needleless connector in use. You will need to obtain, read, and analyze the supporting evidence they share with you. Finally, I don't think we will ever really be able to manually scrub any needleless connector to render it safe for use. I think passive disinfection caps are necessary. We have very good clinical evidence about CLABSI reduction from published studies on these caps.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
An article by Curran (2016, Jnl of Infection Prevention) refers to Epic3 (IVAD30) recommendation for a 15 second scrub. However, the evidence is non-analytic studies and expert opinion, so the evidence is weak. Curran supported the 15 sec recommendation, in part, because a longer scrub time is needed to disinfect for "heavy contamination." Since one cannot ascertain at the bedside which needleless connector has "heavy contaminiation," she recommends 15 sec scrub with antiseptic drying. (Epic 3 are UK NHS guidelines for preventing HAI.)