Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit.
Publication/Presentation Date
2-1-2006
Abstract
BACKGROUND: In the academic trauma unit during initial evaluation and resuscitation of trauma victims, central venous catheters are often placed by multiple operators. There are few data on compliance with accepted, standard sterile practices during such procedures.
METHODS: Prospective data were tabulated from video capture of 144 consecutive central venous catheterizations in a trauma resuscitation unit, during peak hours, by a team of trained video technicians. The physicians were surgical and emergency medicine residents. The number of primary operators (trainees) and secondary operators (mentors) for each line was recorded from the video analysis, as well as physician adherence to the use of maximum barrier precautions (MBP; sterile gown, gloves, full operative drape, cap, and mask). Procedures were stratified by level of urgency: Emergent (n = 7), semi-emergent (n = 20), and elective (n = 113).
RESULTS: The subclavian vein was used for 73% of the elective catheter placements. For elective central venous catheters, 99 of 113 primary operators (88%) observed MBP, whereas only 31 of 45 secondary operators (69%) did so (p < or = 0.01). Among the 45 elective central venous catheters placed with a secondary operator, there were four instances of frank contamination (9%).
CONCLUSIONS: Secondary operators, typically trauma surgery attendings, trauma/critical care fellows, or senior surgical residents, function as mentors in academic institutions and act as role models. Secondary operators participated in many of the studied cases, yet failed to demonstrate consistent use of MBP. In elective central venous catheter placement, those where there was the greatest opportunity to follow MBP, we observed a statistically significant difference in compliance rate between the primary and secondary operators. The study suggests the need to address the performance of the secondary operators and to educate them, as although they may be technically experienced in placing central venous catheters, they may comply less consistently with MBP.
Volume
7
Issue
1
First Page
15
Last Page
20
ISSN
1096-2964
Published In/Presented At
Guzzo, J. L., Seagull, F. J., Bochicchio, G. V., Sisley, A., Mackenzie, C. F., Dutton, R. P., Scalea, T., & Xiao, Y. (2006). Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit. Surgical infections, 7(1), 15–20. https://doi.org/10.1089/sur.2006.7.15
Disciplines
Medicine and Health Sciences
PubMedID
16509781
Department(s)
Department of Surgery
Document Type
Article