title: Aseptic technique for accessing central venous catheters: applying a standardised tool to audit 'scrub the hub' practices.
abstract: BACKGROUND
  To reduce the risk of infections associated with indwelling central venous catheters (CVCs), practices for hub disinfection have been widely promoted. The objective of this study was to design and implement a standardised tool to monitor compliance with 'scrub the hub' practices at an Australian centre.
  
  
  METHODS
  Review of existing literature and recommendations regarding scrub the hub practices was performed to identify nine key components that could be audited by direct observation of staff in clinical areas. The tool was reviewed by stakeholders in infection prevention, infectious diseases and senior nursing roles prior to pilot evaluation.
  
  
  RESULTS
  Twenty attempts to access a CVC were audited. In all instances, scrub the hub practices were commenced. However, a 15-second scrub was performed in only 60% of cases, and the hub was permitted to dry in only 65% of instances. With respect to maintaining an aseptic field, the overall compliance was 40%, and compliance was lowest for maintenance of a non-touch technique for key parts and sites, and hand hygiene practices following CVC access.
  
  
  CONCLUSIONS
  A standardised clinical audit tool for monitoring aseptic access of CVCs enabled identification of practices amendable to targeted intervention and education, such as duration of hub disinfection. This tool would be readily utilised to facilitate quality improvement initiatives in a range of healthcare contexts, including high-risk inpatient and ambulatory care settings.
authors: Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Victoria - Australia.
authors: Andra P
authors: AP
authors: Desra
authors: Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Victoria - Australia.
authors: Jennifer
authors: J
authors: Breen
authors: Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Victoria - Australia.
authors: Susan
authors: S
authors: Harper
authors: Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Victoria - Australia.|Department of Medicine, University of Melbourne, Victoria - Australia.
authors: Monica A
authors: MA
authors: Slavin
authors: Department of Infectious Diseases and Infection Prevention, Peter MacCallum Cancer Centre, Victoria - Australia.|Department of Medicine, University of Melbourne, Victoria - Australia.
authors: Leon J
authors: LJ
authors: Worth
mesh_terms: D001207:Asepsis / Q000379:methods* / Q000592:standards; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D057189:Checklist; D004203:Disinfection / Q000379:methods* / Q000592:standards; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D017410:Practice Guidelines as Topic; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D016896:Treatment Outcome; D014739:Victoria