title: Human factors related to time-dependent infection control measures: "Scrub the hub" for venous catheters and feeding tubes.
abstract: BACKGROUND
  The use of catheter hub decontamination protocols is a common practice to reduce central line-associated bloodstream infections. However, few data exist on the most effective disinfection procedure prior to hub access accounting for human factors and time-dependent practices in real time in the clinical setting.
  
  
  METHODS
  An observational design with a multimodal intervention was used in this study in a neonatal intensive care unit. Direct observations on nurse compliance of scrub times with decontamination when accessing of venous catheter and feeding tube hubs were conducted during 3 phases: (1) baseline period prior to any interventions; (2) during an educational intervention phase; and (3) during a timer intervention period when using a timing device, either an actual timer or music button.
  
  
  RESULTS
  Overall, both education and the timing device interventions increased the mean scrub time ± SD of venous catheter hubs. Mean baseline scrub times of 10 ± 5 seconds were lower compared with 23 ± 12 seconds after educational intervention (P < .002) and 31 ± 8 seconds with timer or music button use (P < .001). Timer intervention scrub time was also more effective than education alone (P < .05). Similar findings were observed with scrub times of feeding tubes.
  
  
  CONCLUSIONS
  Time-based infection control measures, such as scrubbing the hub, must be implemented with aids that qualify specific times to account for human factors, to ensure adherence to time-dependent measures aimed at decreasing nosocomial infections.
authors.affiliation: Inova Health System, Fairfax, VA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Caspari
authors.affiliation: University of Virginia School of Nursing, Charlottesville, VA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Epstein
authors.affiliation: University of Virginia Health System, Charlottesville, VA.
authors.forename: Amy
authors.initials: A
authors.lastname: Blackman
authors.affiliation: University of Virginia Health System, Charlottesville, VA.
authors.forename: Li
authors.initials: L
authors.lastname: Jin
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Virginia Medical School, Charlottesville, VA. Electronic address: davidkaufman@virginia.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Kaufman
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D003428:Cross Infection / Q000517:prevention & control; D004203:Disinfection / Q000379:methods / Q000592:standards; D004750:Enteral Nutrition / Q000295:instrumentation*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D007363:Intensive Care Units, Neonatal / Q000592:standards; D008297:Male; D013997:Time Factors
keywords: Central line–associated bloodstream infections; Feeding tubes; Hub disinfection; Human factors; Infection control