基于模拟的培训在中央静脉导管置管过程中对护士进行无菌技术

Simulation-based training for nurses in sterile techniques during central vein catheterization.

机构信息

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.

出版信息

Am J Crit Care. 2014 Jan;23(1):40-8. doi: 10.4037/ajcc2014860.

DOI:10.4037/ajcc2014860

PMID:24382616

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.

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.

摘要

背景

目前尚未确定基于模拟的重症监护护士无菌技术培训的效果。

目的

评估基于模拟的重症监护护士无菌技术培训在中心静脉导管置管过程中的效果，以及该培训对感染率的影响。

方法

这是一项前瞻性对照研究，对 23 张床位的内科、外科、神经重症监护病房进行为期 12 个月的观察性随访，以评估导管相关性血流感染的发生率。

结果

46 名重症监护护士在模拟实验室完成了无菌技术技能评估和培训。基线时的操作评分较差：每个类别中的中位数评分为 0 至 2 分（满分 4 分），中位数总分为 7 分（满分 24 分）。经过基于模拟的培训后，护士在每个 ST 类别中的中位数评分和总评分均显著提高，总评分中位数提高至 23 分（P<.01；中位数差异，15；95%置信区间，14-16）。完成基于模拟的培训干预后，单位的平均感染率从 2.61 例/1000 导管日降至 0.4 例（P=.02）。泊松回归得出的发病率比（0.15；95%置信区间，0.03-0.78）表明，干预后单位导管相关性血流感染的发生率降低了 85%。