HINT: How long do I need to scrub the hub of a central venous access device (CVAD) cap?
Connected Care Quick Hits are up to date and evidence based recommendations for the care of children with medical complexity & technology dependence, from hospital to home.
HINT: How long do I need to scrub the hub of a central venous access device (CVAD) cap?
SITUATION:
This QuickHit is informed by family caregivers who report observing that there is a difference in how long they scrub the hub of their child's CVAD cap (top and sides) and allow it to dry compared to their home care providers.
BACKGROUND:
Children with CVADs are at risk for central line associated blood stream infections (CLABSIs). These infections can occur when bacteria enter the blood stream through key sites (e.g., CVL/PICC insertion sites) or key parts (e.g., caps).
Aseptic non-touch technique (ANTT) is used to prevent infection when accessing CVAD caps. In ANTT, asepsis is ensured by identifying and protecting key sites and key parts through hand hygiene, using non-touch technique, using new single-use supplies, and cleaning existing key parts to a standard that renders them aseptic prior to access.
The outside of the cap is considered contaminated. 70% alcohol has effective antimicrobial properties and a quick dry time. Proper friction and time for the alcohol to dry are the two ways bacteria are removed.
This photo of bacteria under black light shows how much more bacteria is removed when the cap is scrubbed for 15 seconds.
ASSESSMENT:
When setting up for CVAD care, assess and plan for ANTT by:
Identifying key sites and key parts
Using a designated flat, stable, and clean surface (some families may use a designated cookie tray as a work surface)
Organizing necessary supplies
Having a strategy to time scrubbing and drying times, instead of counting out the seconds. We often count faster than we think:
Use an analog clock
Set a timer on your phone
Sing the ‘ABCs’ song
RECOMMENDATION:
Connected Care recommends keeping the ‘30 or it's dirty’ rule in mind when accessing the CVAD site and following the procedure below:
Perform hand hygiene. Apply clean gloves.
Pick up an alcohol swab with dominant hand and actively scrub the hub of the cap (top and sides) for 15 seconds using vigorous friction.
Allow the cap to air dry for an additional 15 seconds.
Use a second alcohol swab to do a swipe of the cap between syringes, if any blood/contaminant is visibly present.
If the cap becomes contaminated, then perform another 15 second scrub and dry for 15 seconds.
