Effectiveness of catheter hub sanitation prior to dialysis

Abstract

Purpose: Contamination of catheter hub connectors is known to cause catheter‐related blood stream infections in patients undergoing hemodialysis via central venous catheters (CVC). The effectiveness of cleansing the hub with an antimicrobial agent was assessed by culturing the surface of the hub following sanitation. Methods: The CVC hub connectors of 24 patients were sanitized using the standard hospital protocol of aseptically swabbing the connectors with a solution of bleach or Betadine, and then bathing the hub in sterile gauze soaked with the antimicrobial solution for 5 minutes. The exterior surface of the hub was then cultured for a broad spectrum of microorganisms. Patients were monitored for exit site infection, tunnel infection, and septicemia. In the laboratory, sterile hubs were inoculated with E. coli, staph. aureus neg., and yeast. Hubs were then immersed in Betadine for 5, 10, or 30 min. and cultures were taken. Results: Positive cultures were obtained from the hubs of 17 of the 24 patients. Seven (7) of the patients with positive results developed bacteremia from the cultured organism within 7 weeks. Positive cultures were obtained from 50% of inoculated lab samples after 5 min, 10% after 15 min, and 0% after 30 min. of immersion sanitation. Conclusions: The techniques for cleansing CVC hubs should be revisited.