Board 305 - Research Abstract Dissemination of a Simulation-Based Mastery Learning Intervention Reduces Central Line-Associated Bloodstream Infections (Submission #202)

Abstract

Introduction/Background Approximately 41,000 central line-associated bloodstream infections (CLABSI) occur yearly in U.S. hospitals.1 Despite strategies such as checklists, many hospitals have not been able to reduce CLABSI rates.2 We previously developed a simulation-based mastery learning (SBML) curriculum in central venous catheter (CVC) insertion that significantly reduced CLABSI rates.3 The aim of the current study was to measure the effect of dissemination and implementation of the SBML curriculum developed at a tertiary care medical center on trainee skills and CLABSI rates at a community hospital. Methods We performed a cohort study of all internal medicine and emergency medicine residents before their intensive care unit (ICU) rotation at Mercy Hospital (an academic community hospital) from September 2010 to May 2012. Residents underwent a CVC SBML curriculum before their ICU rotation. We evaluated residents simulated internal jugular (IJ) and subclavian (SC) CVC insertion skills before and after the educational intervention using a 29 item checklist. All residents were required to meet or exceed a minimum passing score at post-test before completion of training. Subsequently, we evaluated the effects of the SBML training program on CLABSI rates at Mercy hospital. We compared CLABSI rates from October 2008 to August 2010 (pre-intervention) to September 2010 to May 2012 (post-intervention). Results The mean IJ pretest score was 35.5% (10.29/29, SD = 8.30) compared to a post-test mean of 93.0% (26.96/29, SD = 1.50; P < 0.001). The mean SC pretest score was 23.0% (6.68/29; SD = 9.58) and increased to 96.1% (27.88/29, SD = 1.41) at post-test (P < 0.001). There were 3.82 infections per 1000 catheter-days (20 infections in 5235 catheter-days) in the ICU in the 23 months before the educational intervention. During the 21 months after the intervention there were 1.29 infections per 1000 catheter-days (6 infections in 4670 catheter days). Patients in the ICU had significantly fewer CLABSIs after the SBML intervention (P = 0.019). The incidence rate ratio was 0.257 (95% CI, 0.089-0.742) after controlling for APACHE III scores. Conclusion This study demonstrates successful dissemination and implementation of a CVC SBML curriculum at a community academic hospital. The intervention significantly improved resident CVC insertion skills and reduced CLABSI rates. This collaboration illustrates how medical educators can use evidence-based training Methods to improve patient care.