A multitiered strategy of simulation training, kit consolidation, and electronic documentation is associated with a reduction in central line-associated bloodstream infections.
BACKGROUND
Simulation-based training has been associated with reduced central line-associated bloodstream infection (CLABSI) rates. We measured the combined effect of simulation training, electronic medical records (EMR)-based documentation, and standardized kits on CLABSI rates in our medical (MICU) and surgical (SICU) intensive care units (ICU).


METHODS
CLABSI events and catheter-days were collected for 19 months prior to and 37 months following an intervention consisting of simulation training in central line insertion for all ICU residents, incorporation of standardized, all-inclusive catheter kits, and EMR-guided documentation. Supervising physicians in the MICU (but not the SICU) also completed training.


RESULTS
Following the intervention, EMR-based documentation increased from 48% to 100%, and documented compliance with hand hygiene, barrier precautions, and chlorhexidine use increased from 65%-85% to 100%. CLABSI rate in the MICU dropped from 2.72 per 1,000 catheter-days over the 19 months preceding the intervention to 0.40 per 1,000 over the 37 months following intervention (P = .01) but did not change in the SICU (1.09 and 1.14 per 1,000 catheter-days, P = .86). This equated to 24 fewer than expected CLABSIs and $1,669,000 in estimated savings.


CONCLUSIONS
Combined simulation training, standardized all-inclusive kits, and EMR-guided documentation were associated with greater documented compliance with sterile precautions and reduced CLABSI rate in our MICU. To achieve maximal benefit, refresher training of senior physicians supervising practice at the bedside may be needed.
Department of Medicine, College of Medicine, University of Vermont, Burlington, VT; Fletcher Allen Health Care, Burlington, VT; Fletcher Allen/University of Vermont Clinical Simulation Laboratory, University of Vermont, Burlington, VT. Electronic address: Gil.Allen@uvm.edu.
Gilman B
GB
Allen
Fletcher Allen Health Care, Burlington, VT; Department of Anesthesiology, College of Medicine, University of Vermont, Burlington, VT.
Vincent
V
Miller
Fletcher Allen/University of Vermont Clinical Simulation Laboratory, University of Vermont, Burlington, VT; Departments of Family Medicine and Obstetrics and Gynecology, College of Medicine, University of Vermont, Burlington, VT.
Cate
C
Nicholas
James M. Jeffords Institute for Quality and Operational Effectiveness, Fletcher Allen Health Care, Burlington, VT.
Sally
S
Hess
Department of Nursing, Fletcher Allen Health Care, Burlington, VT.
Mari K
MK
Cordes
Fletcher Allen Health Care, Burlington, VT; Department of Surgery, College of Medicine, University of Vermont, Burlington, VT.
John B
JB
Fortune
James M. Jeffords Institute for Quality and Operational Effectiveness, Fletcher Allen Health Care, Burlington, VT.
Joan
J
Blondin
Medical Biostatistics Unit, College of Medicine, University of Vermont, Burlington, VT.
Takamaru
T
Ashikaga
Fletcher Allen Health Care, Burlington, VT; Fletcher Allen/University of Vermont Clinical Simulation Laboratory, University of Vermont, Burlington, VT; Department of Surgery, College of Medicine, University of Vermont, Burlington, VT; Department of Surgery, Central Maine Heart and Vascular Institute, Lewiston, ME.
Michael
M
Ricci
D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters / Q000009:adverse effects; D003428:Cross Infection / Q000517:prevention & control; D004282:Documentation; D057286:Electronic Health Records; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007318:Inservice Training; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data*; D007396:Internship and Residency; D018805:Sepsis / Q000517:prevention & control*
Catheter-related bloodstream infection; Critical care; Intensive care