Central venous catheters (CVC) are often inserted by housestaff physicians, yet CVC have potential for mechanical and infectious complications. Risk for complications is increased with knowledge deficits and inexperience - factors that may be improved with a structured educational and simulation experience.
An educational program consisting of powerpoint slides with embedded audio and video clips, vascular ultrasound demonstration, plus hands-on stations using task simulators (CentraLineMan, Simulab, Seattle) for a) internal jugular and subclavian venipuncture, and b) comprehensive (20 step) CVC insertion were developed and implemented. Pre- and post-education 10-question test results, surveys regarding confidence with CVC and satisfaction with the program (Lykert score 1–5), and institutional ICU rates for catheter-related bloodstream infection (BSI) were used to evaluate the program. This program is a core feature of an institution-wide effort to reduce nosocomial infections.
From April 2006 to April 2009, more than 900 participants (488 medical students, 418 clinical housestaff physicians, and 8 advanced practice nurses) completed this comprehensive program. All clinical housestaff services (Medicine, Surgery, Anesthesiology, Emergency Medicine, etc) received training. Many individuals received additional informal refresher sessions during ICU rotations. Approximately 460 instructor hours (faculty, fellows, senior housestaff) were required for the formal sessions. Pooled results for medical students and housestaff physicians indicate improvement in test scores from 60% correct pre-course to 90% correct post-course, and improvement in overall confidence from 2.6 (i.e. “minimally confident” (2) to “somewhat confident” (3)) to 3.8 (i.e. “confident” (4)). 99% “strongly agreed” or “agreed” that the program was worthwhile. Institution-wide ICU BSI rates fell from 7.7/1000 CVC-days in 2005 to 3.1/1000 CVC-days in 2008.
This comprehensive educational and task simulation program for CVC was highly regarded by participants, improved knowledge and operator confidence, and was associated with improved rates of catheter-related BSI. Successful implementation required a dedicated group of instructors.
Implementation of a comprehensive institution-wide educational and task simulation program is feasible and contributes to reduced nosocomial infection rates as well as greater operator knowledge, skill, and confidence.
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