Xiao Yan, Seagull F Jacob, Bochicchio Grant V, Guzzo James L, Dutton Richard P, Sisley Amy, Joshi Manjari, Standiford Harold C, Hebden Joan N, Mackenzie Colin F, Scalea Thomas M
Program in Trauma, Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, USA.
Crit Care Med. 2007 May;35(5):1302-6. doi: 10.1097/01.CCM.0000263457.81998.27.
To evaluate the effect of an online training course containing video clips of central venous catheter insertions on compliance with sterile practice.
Prospective randomized controlled study.
Admitting area of a university-based high-volume trauma center.
Surgical and emergency medicine residents rotating through the trauma services.
An online training course on recommended sterile practices during central venous catheter insertion was developed. The course contained short video clips from actual patient care demonstrating common noncompliant behaviors and breaks regarding recommended sterile practices. A 4-month study with a counterbalanced design compared residents trained by the video-based online training course (video group) with those trained with a paper version of the course (paper group). Residents who inserted central venous catheters but received neither the paper nor video training were used as a control group. Consecutive central venous catheter insertions from 12 noon to 12 midnight except Sundays were video recorded.
Sterile-practice compliance was judged through video review by two surgeons blinded to the training status of the residents. Fifty residents inserted 73 elective central venous catheters (19, 31, and 23 by the video, paper, and control group operators, respectively) into 68 patients. Overall compliance with proper operator preparation, skin preparation, and draping was 49% (36 of 73 procedures). The training had no effect on selection of site and skin preparation agent. The video group was significantly more likely than the other two groups to fully comply with sterile practices (74% vs. 33%; odds ratio, 6.1; 95% confidence interval, 2.0-22.0). Even after we controlled for the number of years in residency training, specialty, number of central venous catheters inserted, and central venous catheter site chosen, the video group was more likely to comply with recommended sterile practices (p = .003).
An online training course, with short video clips of actual patient care demonstrating noncompliant behaviors, improved sterile-practice compliance for central venous catheter insertion. Paper handouts with equivalent content did not improve compliance.
评估包含中心静脉导管插入视频片段的在线培训课程对无菌操作依从性的影响。
前瞻性随机对照研究。
一所大学附属的高容量创伤中心的收治区域。
轮转创伤服务的外科和急诊医学住院医师。
开发了一个关于中心静脉导管插入过程中推荐无菌操作的在线培训课程。该课程包含来自实际患者护理的短视频片段，展示了常见的不符合推荐无菌操作的行为和违规情况。一项为期4个月的采用平衡设计的研究，将通过基于视频的在线培训课程培训的住院医师（视频组）与接受纸质版课程培训的住院医师（纸质组）进行比较。插入中心静脉导管但未接受纸质或视频培训的住院医师作为对照组。除周日外，从中午12点到午夜12点的连续中心静脉导管插入操作进行视频记录。
由对住院医师培训状态不知情的两名外科医生通过视频回顾来判断无菌操作依从性。50名住院医师为68名患者插入了73根择期中心静脉导管（视频组、纸质组和对照组操作人员分别插入19根、31根和23根）。在操作人员准备、皮肤准备和铺巾方面的总体依从率为49%（73例操作中的36例）。培训对穿刺部位选择和皮肤准备剂的选择没有影响。视频组完全遵守无菌操作的可能性显著高于其他两组（74%对33%；优势比，6.1；95%置信区间，2.0 - 22.0）。即使在我们控制了住院医师培训年限、专业、插入中心静脉导管的数量以及选择的中心静脉导管部位后，视频组仍更有可能遵守推荐的无菌操作（p = 0.003）。
一个包含实际患者护理短视频片段以展示违规行为的在线培训课程，提高了中心静脉导管插入的无菌操作依从性。具有同等内容的纸质讲义并未提高依从性。
