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Original Research: CRITICAL CARE |

Performance of Medical Residents in Sterile Techniques During Central Vein Catheterization: Randomized Trial of Efficacy of Simulation-Based Training

Hassan Khouli, MD, FCCP; Katherine Jahnes, MD; Janet Shapiro, MD, FCCP; Keith Rose, MD; Joseph Mathew, MD; Amit Gohil, MD; Qifa Han, PhD; Andre Sotelo, MD; James Jones, MD; Adnan Aqeel, MD; Edward Eden, MD, FCCP; Ethan Fried, MD
Author and Funding Information

From the Department of Medicine (Drs Khouli, Shapiro, Rose, Han, Sotelo, Jones, Aqeel, and Fried), and the Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Eden), St Luke’s-Roosevelt Hospital Center, New York, NY; the Department of Emergency Medicine (Dr Jahnes), New York Methodist Hospital, New York, NY; the Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Mathew), Beth Israel Medical Center, New York, NY; and the Department of Medicine (Dr Gohil), Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA.

Correspondence to: Hassan Khouli, MD, Critical Care, St. Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1000 10th Ave, Critical Care Administration, Suite 8C-05, New York, NY 10019; e-mail: hkhouli@chpnet.org


Funding/Support: This study was supported by internal departmental support from the Department of Medicine, St. Luke’s-Roosevelt Hospital Center.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(1):80-87. doi:10.1378/chest.10-0979
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Background:  Catheter-related bloodstream infection (CRBSI) is a preventable cause of a potentially lethal ICU infection. The optimal method to teach health-care providers correct sterile techniques during central vein catheterization (CVC) remains unclear.

Methods:  We randomly assigned second- and third-year internal medicine residents trained by a 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 medical ICU (MICU). A surgical ICU (SICU) 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 1,000 catheter-days.

Results:  Of the 47 enrolled residents, 24 were randomly assigned to the simulation-based plus video training group and 23 to the video training group. Median baseline scores in both groups were equally poor: 12.5 to 13 (52%-54%) out of maximum score of 24 (P = .95; median difference, 0; 95% CI, 0.2-2.0). After training, median score was significantly higher for the simulation-based plus video training group: 22 (92%) vs 18 (75%) for the video training group (P < .001; median difference, 4; 95% CI, 3-6). During the follow-up period, there was a significantly lower rate of CRBSI in the MICU (1.0 per 1,000 catheter-days) compared with the SICU (3.4 per 1,000 catheter-days) (P = .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 postintervention MICU compared with the preintervention MICU and the postintervention 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 used to reduce iatrogenic risk.

Trial Registry:  ClinicalTrials.gov; No.: NCT00612131; URL: clinicaltrials.gov.

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