title: Video-assisted structured teaching to improve aseptic technique during neuraxial block.
abstract: BACKGROUND
  Teaching epidural catheter insertion tends to focus on developing manual dexterity rather than improving aseptic technique which usually remains poor despite increasing experience. The aim of this study was to compare epidural aseptic technique performance, by novice operators after a targeted teaching intervention, with operators taught aseptic technique before the intervention was initiated.
  
  
  METHODS
  Starting July 2008, two groups of second-year anaesthesia residents (pre- and post-teaching intervention) performing their 4-month obstetric anaesthesia rotation in a university affiliated centre were videotaped three to four times while performing epidural procedures. Trained blinded independent examiners reviewed the procedures. The primary outcome was a comparison of aseptic technique performance scores (0-30 points) graded on a scale task-specific checklist.
  
  
  RESULTS
  A total of 86 sessions by 29 residents were included in the study analysis. The intraclass correlation coefficient for inter-rater reliability for the aseptic technique was 0.90. The median aseptic technique scores for the rotation period were significantly higher in the post-intervention group [27.58, inter-quartile range (IQR) 22.33-29.50 vs 16.56, IQR 13.33-22.00]. Similar results were demonstrated when scores were analysed for low, moderate, and high levels of experience throughout the rotation.
  
  
  CONCLUSIONS
  Procedure-specific aseptic technique teaching, aided by video assessment and video demonstration, helped significantly improve aseptic practice by novice trainees. Future studies should consider looking at retention over longer periods of time in more senior residents.
authors.affiliation: Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, 600 University Avenue, Toronto, ON, M5G1X5, Canada. zeev.friedman@uhn.ca
authors.forename: Z
authors.initials: Z
authors.lastname: Friedman
authors.forename: N
authors.initials: N
authors.lastname: Siddiqui
authors.forename: S
authors.initials: S
authors.lastname: Mahmoud
authors.forename: S
authors.initials: S
authors.lastname: Davies
mesh_terms: D000767:Anesthesia, Epidural / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D009407:Nerve Block / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D014743:Videotape Recording
keywords: epidural block; neuraxial aseptic technique; resident assessment; training