Scrub the Hub: Revisiting the Origins and Realities of Catheter Hub Disinfection
Vascular access devices are essential for modern hospital care, but they also carry infection risks. Catheter-related bloodstream infections (CRBSIs) occur when bacteria or other pathogens enter the bloodstream via a catheter, often through manipulation of the catheter hub or needleless connector. When these infections occur in a central line specifically and meet strict clinical definitions, they are classified as central line–associated bloodstream infections (CLABSIs). While CLABSI is a surveillance definition used by healthcare systems for reporting and benchmarking, CRBSI is a broader clinical term that includes any bloodstream infection linked to a vascular device1.
One of the most important infection prevention practices to emerge over the past two decades is the disinfection of needleless connectors prior to each access, a protocol now widely known as “Scrub the Hub.” This simple but critical step is recognised internationally as a cornerstone of safe vascular access.
The Origins of Scrub the Hub
The importance of hub disinfection became widely recognised in the early 2000s as studies began documenting how easily catheter hubs could become contaminated, often through touch contamination or non-sterile technique. At the time, catheter maintenance guidelines were primarily focused on insertion technique and dressing care. However, it became increasingly clear that contamination at the point of access was a major source of bloodstream infections.
“Scrub the Hub” emerged as a campaign and practice standard, recommending disinfection of needleless connectors with 70% isopropyl alcohol or chlorhexidine-alcohol prior to each line access. Today, this recommendation is embedded in hospital policies and national guidelines. When done correctly and consistently, hub disinfection has been shown to significantly reduce CRBSI and CLABSI rates2.
The Impact on Infection Rates
Evidence has consistently shown that compliance with catheter care bundles, including hub disinfection leads to dramatic reductions in bloodstream infection rates. A landmark quality improvement campaign in U.S. intensive care units between 2001 and 2009 saw a 58% drop in CLABSI incidence, with “Scrub the Hub” identified as a key element3.
Subsequent research has linked proper hub disinfection to reduced catheter colonisation, lower ICU mortality, and fewer bloodstream infections overall4. However, the benefit depends entirely on consistent and proper technique which remains an ongoing challenge in real-world practice.
The Cost of Bloodstream Infections
Beyond patient harm, CRBSIs and CLABSIs impose significant financial burdens on healthcare systems. The average cost of a single CLABSI in the United States is estimated at USD $70,696 (approximately NZD $116,000) with ranges reaching as high as USD $100,980 (NZD ~$166,600)5. These costs are driven by longer ICU stays, additional antimicrobial therapy, and the downstream effects of treating systemic infections.
Patients with CRBSIs often remain in hospital an extra 7 to 10 days, and their risk of mortality increases significantly. In some series, the attributable mortality of CRBSIs ranges from 12% to 25%6.
Human Factors: Gaps in Compliance
Despite broad awareness, real-world adherence to “Scrub the Hub” protocols is inconsistent. Studies routinely show that healthcare workers often scrub for far less than the recommended 15 to 30 seconds. Observational audits suggest that scrubbing times are often 5–10 seconds, and drying times are commonly skipped altogether7. In one study, fewer than 10% of staff followed disinfection protocol correctly8.
Human factors such as time pressure, competing priorities, and poor design of connectors all contribute to these lapses. Furthermore, compliance is difficult to audit in real time, meaning there is often no feedback to reinforce proper practice.
To address these issues, healthcare systems are now exploring technologies that allow for rapid disinfection with visual confirmation. These include chromatic indicators that change colour when disinfection is adequately achieved, offering clear, visible proof to users and simplifying compliance auditing. These kinds of solutions may help standardise practice and improve safety in high-risk clinical environments.
Conclusion
The principle behind “Scrub the Hub” is simple: reduce contamination and protect patients. While the technique has remained largely unchanged for years, the challenges around consistent compliance continue to pose real risks.
As we look toward emerging technologies that automate or simplify the disinfection process, it may not always be about scrubbing a hub — but it will always be about making sure vascular access points are safe. Whether through manual disinfection, passive protection, or new emerging devices that help standardise the process, the goal is the same: to prevent infection, support clinical workflows, and protect the people behind the lines.
At Venture Medical, we’re committed to supporting both the practices of today and the innovations of tomorrow.
References
O’Grady, N. P., Alexander, M., Burns, L. A., Dellinger, E. P., Garland, J., Heard, S. O., ... & Saint, S. (2011). Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases, 52(9), e162–e193. https://doi.org/10.1093/cid/cir257 ↩
Ryder, M. (2010). Catheter-related infections: It’s all about biofilm. Topics in Advanced Practice Nursing eJournal, 10(3). ↩
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., ... & Goeschel, C. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725–2732. https://doi.org/10.1056/NEJMoa061115 ↩
Marschall, J., Mermel, L. A., Fakih, M., Hadaway, L., Kallen, A., O’Grady, N. P., ... & Yokoe, D. S. (2014). Strategies to prevent central line–associated bloodstream infections in acute care hospitals: 2014 update. Infection Control & Hospital Epidemiology, 35(7), 753–771. https://doi.org/10.1086/676533 ↩
Agency for Healthcare Research and Quality. (2014). CLABSI Toolkit: Understanding Costs. https://www.ahrq.gov/hai/cusp/clabsi-final-companion/clabsicomp4c.html ↩
Maki, D. G., Kluger, D. M., & Crnich, C. J. (2006). The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings, 81(9), 1159–1171. https://doi.org/10.4065/81.9.1159 ↩
Menegueti, M. G., Laus, A. M., Ciol, M. A., & Auxiliadora-Martins, M. (2021). Disinfection of central venous access device needleless connectors: a human factors analysis. Infection Control & Hospital Epidemiology, 42(3), 323–328. https://doi.org/10.1017/ice.2020.1279 ↩
3M. (2018). The Dirty Truth About IV Access Points: A Global Survey on Disinfection Practices. https://multimedia.3m.com/mws/media/1879386O/3m-curos-the-dirty-truth-about-iv-access-points-english.pdf ↩
