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Performance of Medical Residents in Sterile Techniques during Central Vein Catheterization: Randomized Trial of Efficacy of Simulation-Based Training.
Chest. 2010 Aug 12;
Authors: Khouli H, Jahnes K, Shapiro J, Rose K, Mathew J, Gohil A, Han Q, Sotelo A, Jones J, Aqeel A, Eden E, Fried E
Abstract BACKGROUND: Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal intensive care unit (ICU) infection. The optimal method to teach healthcare providers correct sterile techniques during central vein catheterization (CVC) remains unclear. METHODS: We randomly assigned second and third-year internal medicine residents trained by traditional apprenticeship model to simulation-based plus video-training or video-training alone from December 2007 to January 2008 with a follow-up period to examine CRBSI ending in July 2009. During the follow-up period, a simulation-based training program in sterile techniques during CVC was implemented in the MICU. Surgical ICU where no residents received study interventions was used for comparison. The primary outcome measures were median residents' scores in sterile techniques and rates of CRBSI per 1000 catheter-days. RESULTS: Of the 47 enrolled residents, 24 were randomly assigned to simulation-based plus video-training group and 23 to video-training group. Median baseline scores in both groups were equally poor: 12.5-13 (52-54 %) out of maximum score of 24 (p = 0.95; Median difference 95% CI: 0, 0.2-2.0). After training, median score was significantly higher for simulation-based plus video-training group 22 (92%) vs. 18 (75%) for video-training group (p <0.001; Median difference 95% CI: 4, 3-6). During the follow-up period, there was a significantly lower rate of CRBSI in the MICU (1.0 per 1000 catheter-days) compared to the SICU (3.4 per 1000 catheter-days) (p= 0.03). The incidence rate ratio derived from the Poisson regression (0.30; 95% CI, 0.10-0.91) indicated there was a 70% reduction in the incidence of CRBSI in the post-intervention MICU compared with the pre-intervention MICU and the post-intervention SICU. CONCLUSIONS: Simulation-based training in sterile techniques during CVC is superior to traditional-training or video-training alone and is associated with decreased rate of CRBSI. Simulation-based training in CVC should be routinely utilized to reduce iatrogenic risk.
PMID: 20705795 [PubMed - as supplied by publisher]