Scrubbing out central line infections

catheter hub cleaning
Sarah Goldberg and Ali Ataollahi pitching their device, which cleans central-line hubs with the push of a button, at Boston Children’s Hospital’s Innovation Tank.

Thousands of hospital patients die every year from infections that start in a central line, a catheter used to inject life-saving medications directly into the bloodstream. One infection can add two to three weeks and a whopping $55,000 to a patient’s hospital stay. Even worse, up to 25 percent of patients who come down with a central line infection die from it—a staggering number considering that 41,000 such infections are recorded in the U.S. each year.

“Central line infections are life-threatening, costly and completely preventable,” says Sarah Goldberg, MD, a fellow in Boston Children’s Hospital’s Cardiac Intensive Care Unit (CICU).

The problem is that the catheter’s hub—the port where it enters the body—is exposed to bacteria in the world around it. If clinicians don’t thoroughly clean the hub before each use, they risk pushing bacteria straight into a patient’s blood. But that brings up a second problem.

Guidelines from the U.S. Centers for Disease Control and Prevention (CDC) advise that each time a hub is used, a nurse or doctor should vigorously scrub it for 30 seconds and then let it dry for another 30 seconds before using it:

While critical for patient safety, time spent cleaning hubs can add up quickly. The typical cardiac ICU patient at Boston Children’s Hospital needs 30 to 40 injections a day—that’s 40 minutes of scrubbing and drying per day for each patient, in a setting where every second counts.

Goldberg and cardiac intensivist John Kheir, MD saw how much time this process was taking and started to wonder if hospitals across the country were complying with the CDC guidelines. Turning to the literature, they found some disheartening data. One study reported that 94 percent of hospital providers scrub for less than 15 seconds and nearly half don’t even scrub for three seconds.

Goldberg and Kheir were determined to find a better way to scrub those hubs. Together with Pierre Dupont, PhD, Director of Boston Children’s Pediatric Cardiac Bioengineering Lab, and lab fellow Ali Ataollahi, PhD, they hatched a plan to design a device that would standardize and streamline the hub-cleaning process.

With help from the hospital’s Division of Infectious Diseases and a Boston Children’s Innovestment Grant, the team created a handheld device that can clean and dry a central line hub with the push of a button.

The easy-to-use instrument eliminates human error: Clinicians would simply snap a hub onto the cylindrical device, set the desired amount of scrubbing time and hit the switch. The machine’s tiny bristles scrub the hub faster and harder than a human can, so the team anticipates that hubs will reach the same level of cleanliness in less time than hand scrubbing:

The hub-scrubbing device could put a dent in the $2.34 billion the U.S. currently spends on treating central line infections every year. But more importantly, used in hospitals, outpatient centers like hemodialysis centers and even nursing care, it has the potential to save thousands of lives throughout the country.

Goldberg and Ataollahi presented their prototype at this year’s Innovation Summit, where they were awarded $12,500 and tied for first place in the Innovation Tank competition. Within the next 3 months, they will perform a “bench trial” to test the device’s measurable disease prevention.