Advertisement

Human factors related to time-dependent infection control measures: “Scrub the hub” for venous catheters and feeding tubes

Published:February 15, 2017DOI:https://doi.org/10.1016/j.ajic.2017.01.004

      Highlights

      • Knowledge of existing infection control measures does not imply adherence, particularly when time-based practices and time estimation are necessary aspects of the practice.
      • Institution of timing devices is an effective tool in increasing adherence to time-based–dependent practices.
      • We demonstrated these findings for the hub care of both venous catheters and feeding tubes.
      • Aids that qualify specific times to account for human factors should be implemented to ensure adherence to time-dependent measures aimed at decreasing nosocomial infections.

      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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Curry S.
        • Honeycutt M.
        • Goins G.
        • Gilliam C.
        Catheter-associated bloodstream infections in the NICU: getting to zero.
        Neonatal Netw. 2009; 28: 151-155
        • Pronovost P.
        • Needham D.
        • Berenholtz S.
        • Sinopoli D.
        • Chu H.
        • Cosgrove S.
        • et al.
        An intervention to decrease catheter-related bloodstream infections in the ICU.
        N Engl J Med. 2006; 355: 2725-2732
        • Lange B.J.
        • Weiman M.
        • Feuer E.J.
        • Jakobowski D.
        • Bilodeau J.
        • Stallings V.
        • et al.
        Impact of changes in catheter management on infectious complications among children with central venous catheters.
        Infect Control Hosp Epidemiol. 1997; 18: 326-332
        • Garland J.S.
        • Alex C.P.
        • Sevallius J.M.
        • Murphy D.M.
        • Good M.J.
        • Volberding A.
        • et al.
        Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters.
        Infect Control Hosp Epidemiol. 2008; 29: 243-249
        • Menyhay S.Z.
        • Maki D.G.
        Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap.
        Infect Control Hosp Epidemiol. 2006; 27: 23-27
        • Kaler W.
        • Chinn R.
        Successful discontamination of needleless access ports: a matter of time and friction.
        Journal of Vascular Access Devices. 2007; 12: 140-142
        • Moureau N.L.
        • Flynn J.
        Disinfection of needleless connector hubs: clinical evidence systematic review.
        Nurs Res Pract. 2015; 2015: 796762
        • Mehall J.R.
        • Kite C.A.
        • Gilliam C.H.
        • Jackson R.J.
        • Smith S.D.
        Enteral feeding tubes are a reservoir for nosocomial antibiotic-resistant pathogens.
        J Pediatr Surg. 2002; 37: 1011-1012
        • Mehall J.R.
        • Kite C.A.
        • Saltzman D.A.
        • Wallett T.
        • Jackson R.J.
        • Smith S.D.
        Prospective study of the incidence and complications of bacterial contamination of enteral feeding in neonates.
        J Pediatr Surg. 2002; 37: 1177-1182
        • Hurrell E.
        • Kucerova E.
        • Loughlin M.
        • Caubilla-Barron J.
        • Forsythe S.J.
        Biofilm formation on enteral feeding tubes by Cronobacter sakazakii, Salmonella serovars and other Enterobacteriaceae.
        Int J Food Microbiol. 2009; 136: 227-231
        • Hurrell E.
        • Kucerova E.
        • Loughlin M.
        • Caubilla-Barron J.
        • Hilton A.
        • Armstrong R.
        • et al.
        Neonatal enteral feeding tubes as loci for colonisation by members of the Enterobacteriaceae.
        BMC Infect Dis. 2009; 9: 146
        • Manzoni P.
        • Rinaldi M.
        • Cattani S.
        • Pugni L.
        • Romeo M.G.
        • Messner H.
        • et al.
        Bovine lactoferrin supplementation for prevention of late-onset sepsis in very low-birth-weight neonates: a randomized trial.
        JAMA. 2009; 302: 1421-1428
        • Marmaras N.
        • Vassilakis P.
        • Dounias G.
        Factors affecting accuracy of producing time intervals.
        Percept Mot Skills. 1995; 80: 1043-1056
        • Brown S.W.
        Time perception and attention: the effects of prospective versus retrospective paradigms and task demands on perceived duration.
        Percept Psychophys. 1985; 38: 115-124
        • Rahim R.H.
        • Barnett T.
        Reducing nosocomial infection in neonatal intensive care: an intervention study.
        Int J Nurs Pract. 2009; 15: 580-584
        • Helder O.K.
        • Brug J.
        • Looman C.W.
        • van Goudoever J.B.
        • Kornelisse R.F.
        The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban neonatal intensive care unit: an intervention study with before and after comparison.
        Int J Nurs Stud. 2010; 47: 1245-1252
        • Vermont Oxford Network
        Vermont Oxford Network Database Nightingale Internet Reporting System Burlington: 2008-2011.
        (Available from:) (Accessed July 3, 2014)
        • Cooley K.
        • Grady S.
        Minimizing catheter-related bloodstream infections: one unit's approach.
        Adv Neonatal Care. 2009; 9: 209-226