Simulation-Based Training for Nurses in Sterile Techniques During Central Vein Catheterization

Gerolemou, Louis; Fidellaga, Amelita; Rose, Keith; Cooper, Scott; Venturanza, Majella; Aqeel, Adnan; Han, Qifa; Jones, James; Shapiro, Janet; Khouli, Hassan

doi:10.4037/ajcc2014860

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Patient Safety Issues| January 01 2014

Simulation-Based Training for Nurses in Sterile Techniques During Central Vein Catheterization

Louis Gerolemou, DO;

Louis Gerolemou, DO

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.

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Amelita Fidellaga, RN, BSN, MSHA;

Amelita Fidellaga, RN, BSN, MSHA

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.

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Keith Rose, MD;

Keith Rose, MD

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.

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Scott Cooper, RN, BSN, CCRN-CSC;

Scott Cooper, RN, BSN, CCRN-CSC

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.

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Majella Venturanza, RN, MA, CCRN;

Majella Venturanza, RN, MA, CCRN

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.

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Adnan Aqeel, MD;

Adnan Aqeel, MD

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.

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Qifa Han, PhD;

Qifa Han, PhD

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.

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James Jones, MD;

James Jones, MD

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.

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Janet Shapiro, MD;

Janet Shapiro, MD

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.

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Hassan Khouli, MD

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.

Corresponding author: Hassan Khouli, md, Chief, Critical Care Section, St Luke’s-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1000 10th Avenue, New York, NY 10019 (e-mail: [email protected]).

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Am J Crit Care (2014) 23 (1): 40–48.

https://doi.org/10.4037/ajcc2014860

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.

Conclusion

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.

2014

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