title: Simulation-based training for nurses in sterile techniques during central vein catheterization.
abstract: BACKGROUND
  The effectiveness of simulation-based training of critical care nurses in sterile techniques has not been determined.
  
  
  OBJECTIVE
  To evaluate the effectiveness of simulation-based training of critical care nurses to use sterile techniques during central vein catheterization and the effect of such training on infection rates.
  
  
  METHODS
  A prospective controlled study with 12-month observational follow-up to assess the rate of catheter-related bloodstream infections in a 23-bed medical, surgical, neurological critical care unit.
  
  
  RESULTS
  Forty-six critical care nurses completed assessment and training in sterile technique skills in the simulation laboratory. Performance scores at baseline were poor: median scores in each category ranging from 0 to 2 out of a maximum score of 4 and a median total score of 7 out of a maximum score of 24. After simulation-based training, nurses' median scores in each ST category and their total scores improved significantly, with the median total score increasing to 23 (P < .01; median difference, 15; 95% CI, 14-16). After completion of the simulation-based training intervention, the mean infection rate in the unit was reduced by 85% from 2.61 to 0.4 infections per 1000 catheter-days (P = .02). The incidence rate-ratio derived from the Poisson regression (0.15; 95% CI, 0.03-0.78) indicates an 85% reduction in the incidence of catheter-related bloodstream infections in the unit after the intervention.
  
  
  CONCLUSIONS
  Simulation-based training of critical care nurses in sterile technique is an important component in the strategy to reduce the occurrence of such infections and promote patient safety.
authors.affiliation: All authors are from St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York. Louis Gerolemou is a critical care attending physician, Amelita Fidellaga is an intensive care unit nurse manager, Keith Rose is a critical care attending physician, Scott Cooper is a nurse educator, Majella Venturanza is a critical care nursing director, Adnan Aqeel is a medical resident, Qifa Han is a biostatistician, James Jones is a critical care attending physician, Janet Shapiro is director of the medical intensive care unit, and Hassan Khouli is chief of the critical care section.
authors.forename: Louis
authors.initials: L
authors.lastname: Gerolemou
authors.forename: Amelita
authors.initials: A
authors.lastname: Fidellaga
authors.forename: Keith
authors.initials: K
authors.lastname: Rose
authors.forename: Scott
authors.initials: S
authors.lastname: Cooper
authors.forename: Majella
authors.initials: M
authors.lastname: Venturanza
authors.forename: Adnan
authors.initials: A
authors.lastname: Aqeel
authors.forename: Qifa
authors.initials: Q
authors.lastname: Han
authors.forename: James
authors.initials: J
authors.lastname: Jones
authors.forename: Janet
authors.initials: J
authors.lastname: Shapiro
authors.forename: Hassan
authors.initials: H
authors.lastname: Khouli
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000451:nursing* / Q000592:standards; D003198:Computer Simulation; D064648:Critical Care Nursing / Q000193:education* / Q000379:methods / Q000592:standards; D006801:Humans; D015994:Incidence; D007318:Inservice Training / Q000379:methods; D008348:Manikins; D061214:Patient Safety / Q000592:standards*; D016012:Poisson Distribution; D015397:Program Evaluation; D011446:Prospective Studies; D013242:Sterilization / Q000379:methods / Q000592:standards