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Academia and the Profession |

Education of Physicians-in-Training Can Decrease the Risk for Vascular Catheter Infection

Robert J. Sherertz, MD; E. Wesley Ely, MD, MPH; Debi M. Westbrook, RN; Kate S. Gledhill, RN; Stephen A. Streed, MS; Betty Kiger, RN; Lenora Flynn, MT; Stewart Hayes, RRT; Sallie Strong, RN; Julia Cruz, MD; David L. Bowton, MD; Todd Hulgan, MD; and Edward F. Haponik, MD
[+] Article and Author Information

From North Carolina Baptist Hospital and Wake Forest University School of Medicine, Winston-Salem, North Carolina.


Acknowledgments: The authors thank Ala Jo Koonts and Frank Sizemore for their support of this project.

Requests for Single Reprints: Robert J. Sherertz, MD, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157; e-mail: sherertz@wfubmc.edu.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Sherertz, Cruz, Bowton, and Hulgan, Ms. Westbrook, Ms. Gledhill, Ms. Kiger, Ms. Flynn, Mr. Hayes, and Ms. Strong: Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157.

Dr. Ely: Vanderbilt University Medical Center, 913 Oxford House, Nashville, TN 37232-4760.

Mr. Streed: MRL Pharmaceutical Services, 13665 Dulles Technology Drive, Suite 200, Herndon, VA 20171.

Dr. Haponik: Johns Hopkins Asthma and Allergy Center, 4B.77, 5501 Hopkins Bayview Circle, Baltimore, MD 21225.


Ann Intern Med. 2000;132(8):641-648. doi:10.7326/0003-4819-132-8-200004180-00007
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Background: Procedure instruction for physicians-in-training is usually nonstandardized. The authors observed that during insertion of central venous catheters (CVCs), few physicians used full-size sterile drapes (an intervention proven to reduce the risk for CVC-related infection).

Objective: To improve standardization of infection control practices and techniques during invasive procedures.

Design: Nonrandomized pre-post observational trial.

Setting: Six intensive care units and one step-down unit at Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.

Participants: Third-year medical students and physicians completing their first postgraduate year.

Intervention: A 1-day course on infection control practices and procedures given in June 1996 and June 1997.

Measurements: Surveys assessing physician attitudes toward use of sterile techniques during insertion of CVCs were administered during the baseline year and just before, immediately after, and 6 months after the first course. Preintervention and postintervention use of full-size sterile drapes was measured, and surveillance for vascular catheter-related infection was performed.

Results: The perceived need for full-size sterile drapes was 22% in the year before the course and 73% 6 months after the course (P < 0.001). The perceived need for small sterile towels at the insertion site decreased reciprocally (P < 0.001). Documented use of full-size sterile drapes increased from 44% to 65% (P < 0.001). The rate of catheter-related infection decreased from 4.51 infections per 1000 patient-days before the first course to 2.92 infections per 1000 patient-days 18 months after the first course (average decrease, 3.23 infections per 1000 patient-days; P < 0.01). The estimated cost savings of this 28% decrease was at least $63 000 and may have exceeded $800 000.

Conclusions: Standardization of infection control practices through a course is a cost-effective way to decrease related adverse outcomes. If these findings can be reproduced, this approach may serve as a model for physicians-in-training.

Figures

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Figure.
Effect of a procedure course on the risk for primary bloodstream infection (white bars) and catheter-related infection (striped bars) in six intensive care units and one step-down unit.P

The course was offered twice; participants were medical students and physicians completing their first postgraduate year. The difference between the total number of infections per 1000 patient-days before the first course (baseline) compared with that after the first course is statistically significant ( = 0.01).

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