Purpose: The Centers for Disease Control have published guidelines for the prevention of Catheter Related Blood Stream Infection (CLABI). The interventions emphasize several distinct practices including education and training of healthcare providers, and utilizing maximum sterile barrier precautions (MBP) during central vein catheterization (CVC). Residents most frequently learn CVC by the “see one, do one, teach one” or by watching videotapes. It is not clear if utilization of medical simulation environment that replicates ICU setting to train medical residents in correct MBP is superior to traditional training methods.
Methods: We randomly assigned 2nd and 3rd year medical residents to video (V) only training or video training plus debriefing (V+D) after baseline assessment of each resident's MBP technique. The primary end point was medical residents’ performance score improvement (PSI) in MBP technique during CVC. The secondary end points were CLABI rate in Medical Intensive Care Units (MICU).
Results: 47 medical residents completed the study. After baseline assessment of each resident's performance in MBP, 23 residents were randomized to (V) group and 24 residents were randomized to (V+D) group. Median baseline scores in both groups were equally poor: 13 out of 24 maximum score (54%). After training, both groups improved their median scores with median score and PSI in V+D group significantly better that group V: Median score 18 (75%) for V group, and 22 (92%) for V+D group (p < 0.001), and PSI 5 for group V vs. 10 for V+D group (p = 0.002). MICU CLABI rate post training completion decreased by 41% from 3.4 to 2.0 and by 47% from 3.4 to 1.8 at 6-month and one-year respectively compared to one year before.
Conclusions: Simulation-based training in MBP during CVC is superior to traditional video training and may be associated with decrease CLAB rate in MICU.
Clinical Implications: Future training in MBP techniques during CVC may be modified to include simulation-based training. Such initiative may have significant impact on nosocomial infection and improved patient safety.
Hassan Khouli, No Financial Disclosure Information; No Product/Research Disclosure Information