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

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.

Comparison of traditional and disposable bed baths in critically ill patients.

BACKGROUND: For bedridden patients unable to perform personal hygiene measures because of acute illness or chronic debilitation, the bed bath, with either the traditional basin or, more recently, disposable baths, has long been a measure for improving hygiene and costs. OBJECTIVE: To compare the traditional basin bed bath with a prepackaged disposable bed bath in terms of 4 outcomes: time and quality of bath, microbial counts on the skin, nurses' satisfaction, and costs. METHODS: Forty patients in surgical, medical, or cardiothoracic intensive care units received both types of bath on different days. Baths were observed, timed, and scored for quality. Cultures of the peri-umbilicus and groin were obtained before and after each bath. At the end of the study, nurses were interviewed about their preferences. RESULTS: Neither total quality scores nor microbial counts differed significantly between the 2 bath types. Significantly fewer products (P < .001) and less time were used, cost was lower, and nurses' ratings were significantly better with the disposable bath. CONCLUSION: The disposable bath is a desirable form of bathing for patients who are unable to bathe themselves in critical care and long-term care settings, and it may even be preferable to the traditional basin bath.