Hub Cleansing to Prevent Hub Infection (HUC-PHIN)

Central venous catheter infections are common preventable adverse events among hospital patients. Microbes may enter catheter hubs, also known as needleless connectors, and result in downstream contamination. This study aims to compare alcohol disinfection of catheter hubs to disinfection with chlorhexidine gluconate in alcohol, which has been proven to be a superior disinfectant at the site of central venous catheter insertion. Scrub duration of central venous catheter hubs will also be evaluated.

A prospective randomized blinded crossover clinical trial will be performed in the medical intensive care unit at Rush University Medical Center. The intensive care unit will be divided into two regions (A&B). Hub disinfectants and duration of disinfection will be randomly assigned to these regions. After 1/2 of the study period, the agents will crossover, but the duration of scrubbing will remain the same, analogous to a 2X2 factorial design. Our primary endpoint will be internal contamination of hubs and catheters.

• Other: 15 second scrub
  Catheter hubs are normally cleansed prior to accessing the central venous line. All catheter hubs in this arm will be scrubbed for 15 seconds.
• Other: 5 second scrub
  Catheter hubs are normally cleansed prior to accessing the central venous line. All catheter hubs in this arm will be scrubbed for 5 seconds.
• Drug: 3.15% chlorhexidine/70% isopropyl alcohol
  3.15% chlorhexidine gluconate in 70% isopropyl alcohol pads will be used to disinfect catheter hubs prior to accessing central venous catheters during half of the study period.
  Other Name: Professional Disposables International, Inc. (PDI) Chlorascrub Swab
• Drug: 70% isopropyl alcohol
  70% isopropyl alcohol pads will be used to disinfect catheter hubs prior to accessing central venous catheters for the other half of the study period.
  Other Name: Professional Disposable International, Inc. (PDI) Alcohol Prep Pad

• Experimental: Region A
  One region of the MICU at Rush University Medical Center will be designated region A.
  Interventions:

  • Other: 15 second scrub
  • Drug: 3.15% chlorhexidine/70% isopropyl alcohol
  • Drug: 70% isopropyl alcohol
• Experimental: Region B
  One region of the MICU at Rush University Medical Center will be designated region B.
  Interventions:

  • Other: 5 second scrub
  • Drug: 3.15% chlorhexidine/70% isopropyl alcohol
  • Drug: 70% isopropyl alcohol

Inclusion Criteria:

• Medical intensive care unit patients with non-tunneled central venous catheters

Exclusion Criteria:

• Dialysis catheters
• Antibiotic-impregnated catheters
• Introducer sheaths
• Tunneled catheters