Hoskote Sumedh S, Khouli Hassan, Lanoix Richard, Rose Keith, Aqeel Adnan, Clark Mark, Chalfin Donald, Shapiro Janet, Han Qifa
Department of Medicine, St. Luke's-Roosevelt Hospital Center, Mount Sinai Health System, New York, NY; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
Acad Emerg Med. 2015 Jan;22(1):81-7. doi: 10.1111/acem.12551. Epub 2014 Dec 31.
Central line-associated bloodstream infection (CLABSI) is a preventable nosocomial infection. Simulation-based training in sterile technique during central venous catheter (CVC) placement for emergency medicine (EM) residents, and its effect on changing the medical intensive care unit (MICU) practice of routine replacement of CVCs placed under sterile technique in the emergency department (ED), has not been evaluated.
Emergency medicine residents received simulation-based sterile technique training during CVC placement between May 2008 and September 2010. Between June 2008 and January 2011, the authors reviewed records of patients who had CVCs placed in the ED under sterile technique by EM residents and were admitted to the MICU (group 1) and CVCs placed in the MICU under sterile technique by internal medicine (IM) residents (group 2). IM residents completed similar simulation-based training before May 2008. Changes in EM residents' sterile technique performance scores were compared, as well as CLABSI rates in both groups. EM residents' CVC procedural skills were not assessed.
Seventy-six EM residents completed simulation-based training with significant improvement in performance (median scores 13 out of 24 before training, 24 out of 24 after training; p < 0.001). CLABSI rates per 1,000 catheter-days were 1.02 in group 1 and 1.02 in group 2 (p = 0.99). Both groups had similar demographics, acuity, and mortality (p > 0.5).
Routine replacement of CVCs placed in the ED under sterile technique after simulation-based training would appear to be unnecessary. These findings demonstrate patient-centered outcomes that are comparable for CVCs in ED-admitted MICU patients, regardless of whether the CVC was placed in the ED or MICU.
中心静脉导管相关血流感染（CLABSI）是一种可预防的医院感染。针对急诊医学（EM）住院医师在中心静脉导管（CVC）置入过程中进行基于模拟的无菌技术培训，以及该培训对改变医学重症监护病房（MICU）对在急诊科（ED）采用无菌技术置入的CVC进行常规更换的做法的影响，尚未得到评估。
2008年5月至2010年9月期间，急诊医学住院医师在CVC置入过程中接受了基于模拟的无菌技术培训。2008年6月至2011年1月期间，作者回顾了由急诊医学住院医师在急诊科采用无菌技术置入CVC并入住医学重症监护病房的患者记录（第1组），以及由内科（IM）住院医师在医学重症监护病房采用无菌技术置入CVC的患者记录（第2组）。内科住院医师在2008年5月之前完成了类似的基于模拟的培训。比较了急诊医学住院医师无菌技术操作得分的变化，以及两组的CLABSI发生率。未评估急诊医学住院医师的CVC操作技能。
76名急诊医学住院医师完成了基于模拟的培训，操作表现有显著改善（培训前中位数得分24分中的13分，培训后24分中的24分；p<0.001）。第1组每1000导管日的CLABSI发生率为1.02，第2组为1.02（p=0.99）。两组在人口统计学、病情严重程度和死亡率方面相似（p>0.5）。
基于模拟的培训后，对在急诊科采用无菌技术置入的CVC进行常规更换似乎没有必要。这些发现表明，对于入住医学重症监护病房的急诊科患者，无论CVC是在急诊科还是医学重症监护病房置入，以患者为中心的结果是可比的。
