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Jeffrey H. Barsuk, MD; Elaine R. Cohen, BA; Joe Feinglass, PhD; William C. McGaghie, PhD; Diane B. Wayne, MD

Arch Intern Med. 2009;169(15):1420-1423.

Background  Simulation-based education improves procedural competence in central venous catheter (CVC) insertion. The effect of simulation-based education in CVC insertion on the incidence of catheter-related bloodstream infection (CRBSI) is unknown. The aim of this study was to determine if simulation-based training in CVC insertion reduces CRBSI.

Methods  This was an observational education cohort study set in an adult intensive care unit (ICU) in an urban teaching hospital. Ninety-two internal medicine and emergency medicine residents completed a simulation-based mastery learning program in CVC insertion skills. Rates of CRBSI from CVCs inserted by residents in the ICU before and after the simulation-based educational intervention were compared over a 32-month period.

Results  There were fewer CRBSIs after the simulator-trained residents entered the intervention ICU (0.50 infections per 1000 catheter-days) compared with both the same unit prior to the intervention (3.20 per 1000 catheter-days) (P = .001) and with another ICU in the same hospital throughout the study period (5.03 per 1000 catheter-days) (P = .001).

Conclusions  An educational intervention in CVC insertion significantly improved patient outcomes. Simulation-based education is a valuable adjunct in residency education.

Author Affiliations: Department of Medicine (Drs Barsuk, Feinglass, and Wayne and Ms Cohen) and Augusta Webster, MD, Office of Medical Education and Faculty Development (Dr McGaghie), Northwestern University Feinberg School of Medicine, Chicago, Illinois.

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