Education of physicians-in-training can decrease the risk for vascular catheter infection

Background: Procedure instruction for physicians-in-training is usually non standardized. The authors observed that during insertion of central Venous catheters (CVCs), few physicians used full-size sterile drapes (an interven tion proven to reduce the risk for CVC-related infection). Objective: To improve standardization of infection control practices and te chniques during invasive procedures. Design: Nonrandomized pre-post observational trial. Setting: Six intensive care units and one step-down unit at Wake Forest Uni versity Baptist Medical Center, Winston-Salem, North Carolina. Participants: Third-year medical students and physicians completing their f irst postgraduate year. Intervention: Al-day course on infection control practices and procedures g iven in June 1996 and June 1997. Measurements: Surveys assessing physician attitudes toward use of sterile t echniques during insertion of CVCs were administered during the baseline ye ar and just before, immediately after, and 6 months after the first course. Preintervention and postintervention use of full size sterile drapes was m easured, and surveillance for vascular catheter-related infection was perfo rmed. Results: The perceived need for full-size sterile drapes was 22% in the yea r before the course and 73% 6 months after the course (P < 0.001). The perc eived need for small sterile towels at the insertion site decreased recipro cally (P < 0.001). Documented use of full-size sterile drapes increased fro m 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 c ost savings of this 28% decrease was at least $63 000 and may have exceeded $800 000. Conclusions: Standardization of infection control practices through a cours e is a cost-effective way to decrease related adverse outcomes. If these fi ndings can be reproduced, this approach may serve as a model for physicians -in-training.