The Effect of an Education Program on the Incidence of Central Venous Catheter-Associated Bloodstream Infection in a Medical ICU

Warren, David K.; Zack, Jeanne E.; Mayfield, Jennie; Chen, Alexander; Prentice, Donna; Fraser, Victoria J.; Kollef, Marin H.

doi:10.1378/chest.126.5.1612

Cited by 227 publications

(126 citation statements)

References 25 publications

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“…Mechanisms shown to decrease complications of CVC placement include use of ultrasound, 4,7,33-36 full sterile barrier technique, 37-39 chlorhexidine skin preparations, [40][41][42] and nurse-physician education. 43 Our simulation-training program incorporates each of these elements. We plan to expand our simulation-based training intervention to a larger sample size to determine its impact on mechanical and infectious complication rates linked to CVC insertion.…”

Section: Discussionmentioning

confidence: 99%

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Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

McGaghie

Cohen

Balachandran

et al. 2009

Journal of Hospital Medicine

350

272

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Disclosure: The authors have no financial or other potential conflicts of interest.BACKGROUND: Central venous catheter (CVC) insertions are performed frequently by internal medicine residents.Complications, including arterial puncture and pneumothorax, decrease when operators use fewer needle passes to insert the CVC. In this study, we evaluated the effect of simulation-based mastery learning on CVC insertion skill. DESIGN:This was a cohort study of internal jugular (IJ) and subclavian (SC) CVC insertions by 41 internal medicine residents rotating through the medical intensive care unit (MICU) over a five-month period. Thirteen traditionallytrained residents were surveyed about the number of needle passes, complications, and procedural self-confidence on CVCs inserted in the MICU. Concurrently, 28 residents completed simulation-based training in IJ and SC CVC insertions. Simulator-trained residents were expected to perform CVC insertions to mastery standards on a central line simulator. Simulator-trained residents then rotated through the MICU and were surveyed regarding CVC placement. The impact of simulation training was assessed by comparing group survey results. Central venous catheter (CVC) insertions are commonly performed at the bedside in medical intensive care unit (MICU) settings. Internal medicine residents are required to demonstrate knowledge regarding CVC indications, complications, and sterile technique, 1 and often perform the procedure during training. Education in CVC insertion is needed because many internal medicine residents are uncomfortable performing this procedure. 2 CVC insertion also carries the risk of potentially life-threatening complications including infection, pneumothorax, arterial puncture, deep vein thrombosis, and bleeding. Education and training may also contribute to improved patient care because increased physician experience with CVC insertion reduces complication risk. 3,4 Similarly, a higher number of needle passes or attempts during CVC insertion correlates with mechanical complications such as pneumothorax or arterial punctures. 4-8 Pneumothorax rates for internal jugular (IJ) CVCs have been reported to range from 0% to 0.2% and for subclavian (SC) CVCs from 1.5% to 3.1%. 4,5 The arterial puncture rate for IJ CVCs ranges from 5.0% to 9.4% and for SC CVCs from 3.1% to 4.9%. 4,5 Proper use of ultrasound to assist with IJ CVC insertion has been shown to decrease these mechanical complications. 4,5 However, studies of ultrasound use with SC CVC insertion have mixed results. 4 Simulation-based training has been used in medical education to increase knowledge, provide opportunities for deliberate and safe practice, and shape the development of RESULTS: Journal of Hospital Medicine Vol 4 No 7 September 2009 397clinical skills. 9,10 We previously used simulation-based mastery learning to improve the thoracentesis and advanced cardiac life support (ACLS) skills of internal medicine residents. 11,12 Although a few small studies have linked simulation-based interventions to imp...

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Section: Discussionmentioning

confidence: 99%

“…43 Our simulation-training program incorporates each of these elements. We plan to expand our simulation-based training intervention to a larger sample size to determine its impact on mechanical and infectious complication rates linked to CVC insertion.…”

Section: Journal Of Hospital Medicine Vol 4 No 7 September 2009mentioning

confidence: 99%

Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

McGaghie

Cohen

Balachandran

et al. 2009

Journal of Hospital Medicine

350

272

View full text Add to dashboard Cite

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“…The intervention consisted of five elements: 1) Educational sessions about how to insert and maintain CVCs. [9,10] 2) Cleaning the skin with alcoholic chlorhexidine 0.5%. [11,12] 3) Using a checklist during catheter insertion to ensure adherence to infection-control practices.…”

Section: Methodsmentioning

confidence: 99%

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention

Peredo

Sabatier

Villagrá

et al. 2010

Eur J Clin Microbiol Infect Dis

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“…17 Adherence to these guidelines has been included in successful quality improvement initiatives. 4,5,18 Compared to internists' adherence to recommendations for infection control reported in another survey, 10 residents who attended our educational session reported more use of large sterile drapes (94% vs. 35%) or masks (75% vs. 66%); however, they were less likely to use a sterile gown (50% vs. 72%). Use of a large sterile drape is common in our hospital, likely because the drape is included in the central venous catheter package.…”

Section: Discussionmentioning

confidence: 64%

“…Most quality improvement initiatives directed at reducing complications associated with central venous catheters have focused on patients in the intensive care unit (ICU). 4,5 However, in some hospitals more central venous catheters are inserted in patients not in the ICU, 6 and practices that increase the risk of complications may be more common on wards. 7 In our hospital, most catheters are placed in the femoral vein.…”

mentioning

confidence: 99%

Firm‐based trial to improve central venous catheter insertion practices

Miranda

Trick

Evans

et al. 2007

Journal of Hospital Medicine

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BACKGROUNDCentral venous catheters placed in femoral veins increase the risk of complications. At our institution, residents place most catheters in the femoral vein.OBJECTIVEDetermine whether a hands‐on educational session reduced femoral venous catheterization and improved residents' confidence and adherence to recommendations for infection control.DESIGNFirm‐based clinical trial between November 2004 and March 2005.SETTINGGeneral medical wards of Cook County (Stroger) Hospital (Chicago, IL), a public teaching hospital.PARTICIPANTSInternal medicine residents (n = 150).INTERVENTIONBefore their 4‐week rotation, intervention‐firm residents received a lecture and practiced placing catheters in mannequins; control‐firm residents received the usual training.MEASUREMENTSVenous insertion site, adherence to recommendations for infection control, knowledge and confidence about catheter insertion, and catheter‐associated complicationsRESULTSResidents inserted 54 catheters, or 0.24 insertions per resident per 4‐week rotation. There was a nonsignificant decrease in femoral insertions for nondialysis catheters in the intervention group compared to the control group (44% vs. 58%), difference: −14% (95% CI, −52% to 24%). The intervention significantly increased residents' knowledge of complications related to femoral vein catheterization and temporarily increased their confidence about placing internal jugular or subclavian venous catheters. Intervention‐group residents were more likely to use masks during catheterization (risk ratio, 2.2; 95% CI, 1.3‐2.7), but other practices were similar.CONCLUSIONSOur intervention improved residents' knowledge of complications and use of masks during catheter insertion; however, it did not significantly change venous insertion sites. Catheter insertions on our general medicine wards are infrequent, and the skills acquired during the skills‐building session may have deteriorated given the few clinical opportunities for reinforcement. Journal of Hospital Medicine 2007;2:135–142. © 2007 Society of Hospital Medicine.

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The Effect of an Education Program on the Incidence of Central Venous Catheter-Associated Bloodstream Infection in a Medical ICU

Cited by 227 publications

References 25 publications

Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

Use of simulation‐based mastery learning to improve the quality of central venous catheter placement in a medical intensive care unit

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention

Firm‐based trial to improve central venous catheter insertion practices

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