Simulation-based paediatric intensive care unit central venous line maintenance bundle training

SummaryObjectiveResearch has demonstrated that additional reduction in paediatric catheter associated blood stream infection (CA-BSI) rates can be achieved through improving compliance with maintenance bundle care for central venous lines. Our objective was to improve maintenance bundle compliance rates and nursing competency surrounding central venous line (CVL) care in our paediatric intensive care unit (PICU).MethodsA multidisciplinary team developed a bedside simulation-based training programme to improve compliance with standard PICU CVL maintenance bundle. We then performed a randomised comparison study comparing a standard CVL bundle training process for bedside PICU nurses in a control group (CG) to an intervention group (IG) receiving bedside training to simulate a CVL dressing change and maintenance bundle followed by intermittent training refreshers. Groups were assessed for compliance with prescribed components of the CVL bundle maintenance (CVL score).ResultsAt baseline the CG and IG had similar mean CVL scores (p = 0.725). At twelve months mean CVL bundle compliance score in the IG was significantly higher than in the CG (p < 0.0001). The largest CVL score increase for IG occurred between zero and three months. Coincidentally, CA-BSI rates in the Egleston PICU significantly decreased from 1.9 ± 2.2 BSIs per 1000/CVL days, prior to the study, to 0.6 ± 1.6 BSIs per 1000/CVL days following implementation of the intervention (p = 0.034).ConclusionsBedside simulation based training in CVL dressing change is associated with improved compliance with CVL maintenance bundle practice. Enhanced CVL maintenance bundle practice could contribute to reduction in CA-BSI rates.