TWISTING MOTION Use an alcohol wipe and apply friction for 10 to 15 seconds on every injection port and hub.

Do your nurses and anesthetists scrub the hub, port and vial they're accessing every time they access it? Probably not. After a surveyor cited us because an RN failed to wipe the top of a vial after popping the cap, I wondered how consistently we were disinfecting IV hubs and ports, and the tops of drug vials with an alcohol wipe. Not every time, it turned out. We launched a "Scrub the Hub (Port and Vial)" campaign to remedy that.

When do you scrub the hub? Every time you're about to attach anything onto the injection cap of a peripheral IV. Scrub every potential portal of entry for infection, including injection ports into bags or bottles, injection ports on administration sets, needleless connectors and the hub of a catheter itself. You should cap stopcocks and injection ports when they're not in use.

How do you scrub the hub? Adequately scrubbing the hub depends on the agent you use, appropriate contact and drying time, and — most important — friction. We held a staff in-service to review the steps as outlined by The Joint Commission.

First things first. Perform hand hygiene and don sterile gloves (as required). Then open a new alcohol or chlorhexidine pad to disinfect the catheter hub/port/vial. Unless directed otherwise by the manufacturer's instructions, rub for 10 to 15 seconds or for 30 twists, generating friction by scrubbing in a twisting motion as if you were juicing an orange (15 seconds is longer than you think!). Make sure you scrub the top of the hub/port/vial well, not just the sides. Never reuse alcohol prep pads. Let the hub/port/vial dry. Prevent it from touching anything while drying. Now you're set to infuse medication. Finally, don't forget to perform hand hygiene after you discard the gloves.

As an added precaution to reduce bloodstream infections in patients, you can use alcohol-impregnated port protectors, scrubbing devices and needleless neutral displacement connectors in addition to scrubbing the hub. OSM