title: Simulation-based paediatric intensive care unit central venous line maintenance bundle training.
abstract: OBJECTIVE
  Research has demonstrated that additional reduction in paediatric catheter associated blood stream infection (CA-BSI) rates can be achieved through improving compliance with maintenance bundle care for central venous lines. Our objective was to improve maintenance bundle compliance rates and nursing competency surrounding central venous line (CVL) care in our paediatric intensive care unit (PICU).
  
  
  METHODS
  A multidisciplinary team developed a bedside simulation-based training programme to improve compliance with standard PICU CVL maintenance bundle. We then performed a randomised comparison study comparing a standard CVL bundle training process for bedside PICU nurses in a control group (CG) to an intervention group (IG) receiving bedside training to simulate a CVL dressing change and maintenance bundle followed by intermittent training refreshers. Groups were assessed for compliance with prescribed components of the CVL bundle maintenance (CVL score).
  
  
  RESULTS
  At baseline the CG and IG had similar mean CVL scores (p=0.725). At twelve months mean CVL bundle compliance score in the IG was significantly higher than in the CG (p<0.0001). The largest CVL score increase for IG occurred between zero and three months. Coincidentally, CA-BSI rates in the Egleston PICU significantly decreased from 1.9±2.2 BSIsper 1000/CVL days, prior to the study, to 0.6±1.6 BSIsper 1000/CVL days following implementation of the intervention (p=0.034).
  
  
  CONCLUSIONS
  Bedside simulation based training in CVL dressing change is associated with improved compliance with CVL maintenance bundle practice. Enhanced CVL maintenance bundle practice could contribute to reduction in CA-BSI rates.
authors.affiliation: Children's Healthcare of Atlanta at Egleston, United States; Emory University School of Medicine, United States. Electronic address: kiran.hebbar@choa.org.
authors.forename: Kiran B
authors.initials: KB
authors.lastname: Hebbar
authors.affiliation: Children's Healthcare of Atlanta at Egleston, United States.
authors.forename: Charlene
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Emory University School of Medicine, United States.
authors.forename: Courtney
authors.initials: C
authors.lastname: McCracken
authors.affiliation: Children's Healthcare of Atlanta at Egleston, United States; Emory University School of Medicine, United States.
authors.forename: Pradip
authors.initials: P
authors.lastname: Kamat
authors.affiliation: Children's Healthcare of Atlanta at Egleston, United States; Emory University School of Medicine, United States.
authors.forename: James D
authors.initials: JD
authors.lastname: Fortenberry
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D002648:Child; D064648:Critical Care Nursing / Q000193:education*; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D015278:Intensive Care Units, Pediatric; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000193:education*; D058996:Quality Improvement; D000066908:Simulation Training
keywords: Blood stream infection; Bundle; Central line; Paediatric; Simulation