title: Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit.
abstract: BACKGROUND
  In the academic trauma unit during initial evaluation and resuscitation of trauma victims, central venous catheters are often placed by multiple operators. There are few data on compliance with accepted, standard sterile practices during such procedures.
  
  
  METHODS
  Prospective data were tabulated from video capture of 144 consecutive central venous catheterizations in a trauma resuscitation unit, during peak hours, by a team of trained video technicians. The physicians were surgical and emergency medicine residents. The number of primary operators (trainees) and secondary operators (mentors) for each line was recorded from the video analysis, as well as physician adherence to the use of maximum barrier precautions (MBP; sterile gown, gloves, full operative drape, cap, and mask). Procedures were stratified by level of urgency: Emergent (n = 7), semi-emergent (n = 20), and elective (n = 113).
  
  
  RESULTS
  The subclavian vein was used for 73% of the elective catheter placements. For elective central venous catheters, 99 of 113 primary operators (88%) observed MBP, whereas only 31 of 45 secondary operators (69%) did so (p < or = 0.01). Among the 45 elective central venous catheters placed with a secondary operator, there were four instances of frank contamination (9%).
  
  
  CONCLUSIONS
  Secondary operators, typically trauma surgery attendings, trauma/critical care fellows, or senior surgical residents, function as mentors in academic institutions and act as role models. Secondary operators participated in many of the studied cases, yet failed to demonstrate consistent use of MBP. In elective central venous catheter placement, those where there was the greatest opportunity to follow MBP, we observed a statistically significant difference in compliance rate between the primary and secondary operators. The study suggests the need to address the performance of the secondary operators and to educate them, as although they may be technically experienced in placing central venous catheters, they may comply less consistently with MBP.
authors.affiliation: Department of Surgery, The R. Adams Cowley Shock Trauma Center and University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Guzzo
authors.forename: F Jacob
authors.initials: FJ
authors.lastname: Seagull
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.forename: Amy
authors.initials: A
authors.lastname: Sisley
authors.forename: Colin F
authors.initials: CF
authors.lastname: Mackenzie
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dutton
authors.forename: Thomas
authors.initials: T
authors.lastname: Scalea
authors.forename: Yan
authors.initials: Y
authors.lastname: Xiao
mesh_terms: D002405:Catheterization, Central Venous / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007396:Internship and Residency; D008611:Mentors; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012151:Resuscitation; D013242:Sterilization; D014193:Trauma Centers; D014743:Videotape Recording