title: Prevention of central venous catheter-related bloodstream infections: is it time to add simulation training to the prevention bundle?
abstract: OBJECTIVE
  To study the impact of adding simulation-based education to the pre-intervention mandatory hospital efforts aimed at decreasing central venous catheter-related blood stream infections (CRBSI) in intensive care units (ICU).
  
  
  METHODS
  Pre- and post-intervention retrospective observational investigation.
  
  
  METHODS
  24-bed ICU and a 562-bed university-affiliated, urban teaching hospital.
  
  
  METHODS
  ICU patients July 2004-June 2008 were studied for the development of central venous catheter related blood stream infections (CRBSI).
  
  
  METHODS
  ICU patients from July 2004-June 2008 were studied for the development of central venous catheter-related blood stream infections (CRBSI). PRE-INTERVENTION: mandatory staff and physician education began in 2004 to reduce CRBSI. The CRBSI-prevention program included online and didactic courses, and a pre- and post-test. Elements in the pre-intervention efforts included hand hygiene, full barrier precautions, use of Chlorhexidine skin preparation, and mask, gown, gloves, and hat protection for operators. A catheter-insertion cart containing all supplies and checklist were was a mandatory element of this program; a nurse was empowered to stop the procedure for non-performance of checklist items.
  
  
  METHODS
  As of July 1, 2006, a mandatory simulation-based program for all intern, resident, and fellow physicians was added to teach central venous catheter (CVC) insertion.
  
  
  METHODS
  Data collected pre- and post-intervention were CRBSI incidence, number of ICU catheter days, mortality, laboratory pathogen results, and costs.
  
  
  RESULTS
  The pre-intervention CRBSI incidence of 6.47/1,000 catheter days was reduced significantly to 2.44/1,000 catheter days post-intervention (58%; P < 0.05), resulting in a $539,902 savings (USD; 47%), and was attributed to shorter ICU and hospital lengths of stay.
  
  
  CONCLUSIONS
  Following simulation-based CVC program implementation, CRBSI incidence and costs were significantly reduced for two years post-intervention.
authors.affiliation: Department of Anesthesiology, Cooper University Hospital, Camden, NJ 08103, USA. burden-amanda@cooperhealth.edu
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Burden
authors.forename: Marc C
authors.initials: MC
authors.lastname: Torjman
authors.forename: George E
authors.initials: GE
authors.lastname: Dy
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Jaffe
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Littman
authors.forename: Fiorella
authors.initials: F
authors.lastname: Nawar
authors.forename: S Sujanthy
authors.initials: SS
authors.lastname: Rajaram
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Staman
authors.forename: Annette C
authors.initials: AC
authors.lastname: Reboli
mesh_terms: D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D017046:Cost Savings; D004501:Education, Medical / Q000379:methods*; D017721:Hospital Costs; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007318:Inservice Training / Q000379:methods; D007362:Intensive Care Units / Q000191:economics / Q000592:standards*; D007396:Internship and Residency; D007902:Length of Stay; D008348:Manikins; D012189:Retrospective Studies; D013997:Time Factors