Sustained reduction of catheter-associated bloodstream infections by simulator-training and self-assessment
© Zingg et al; licensee BioMed Central Ltd. 2011
Published: 29 June 2011
Introduction / objectives
Central line-associated bloodstream infection (CLABSI) is an avoidable complication in central venous catheter (CVC) use.
In this study at the University of Geneva Hospitals, individual CVCs were prospectively observed hospital-wide in all adult patients. A baseline period (9/2006-12/2006) was followed by an intervention (1/2008-12/2008) and a sustainability period (1/2009-12/2009). Primary outcome was CLABSI. Interventions aimed at catheter insertion by anaesthesiologists and included (1) a comprehensive checklist, (2) a ready-to-use CVC-insertion set, (3) a CVC-insertion cart containing all necessary material, (4) self-assessment of insertion practice using online documentation, (5) simulation-based CVC-insertion training for residents, (6) web-based information site and (7) feedback during postgraduate education. No intervention was done outside the anaesthesiology division.
Anaesthesiologists, intensivists and other physicians placed 1665 (42%), 1693 (43%), and 617 (15%) catheters, respectively. Cumulative catheter-days and median (IQR) dwell-time were 35,914 and 6 (3-11) days, respectively. Most CVCs were jugular (62%), followed by subclavian (23%) and femoral (15%). CLABSI-rates of anaesthesiologists, intensivists and others at baseline, intervention and sustainability were 4.9, 2.9, 2.0 (IRR 0.75; 95%CI 0.57-0.99; p=0.04); 2.7, 1.4, 2.2 (0.96; 95%CI 0.63-1.46; p=0.85); and 1.6, 2.1, 3.9 (1.54; 95%CI 0.83-2.84; p=0.17), respectively.
Improving CVC-insertion results in significant and sustained CLABSI-reduction. We consider self-assessment at catheter insertion and simulation-based training to have contributed most to the success.
Disclosure of interest
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.