シミュレーションベースの教育による効果：カテーテル感染減少

超音波ガイド下穿刺が普遍的な手技と方向付けされつつあるという・・・

初期臨床研修医に対する超音波ガイド下中心静脈穿刺トレーニング　日本臨床麻酔学会誌
Vol. 28 (2008) , No. 7 956-960　（pdf）

シミュレーションによる教育効果が確かにあるようだ・・・
↓

Use of Simulation-Based Education to Reduce Catheter-Related Bloodstream Infections
Arch Intern Med. 2009;169(15):1420-1423.

http://clinicaltrials.gov/ct2/show/NCT00919308
Control, traditional bedside training
Postgraduate year 1 and 2 residents who are trained in central venous catheter insertion according to the traditional, bedside apprenticeship model.

Simulation training
Postgraduate year 1 and 2 residents who complete a hands-on ultrasound guided simulation training protocol on a partial task training simulator until competence is achieved as measured by: the ability to cannulate a simulated vein under ultrasound guidance on first pass in five consecutive attempts and correct insertion of a central venous cannulator on a partial task training simulator with no technical errors.

simulation training後CRBSI（catheter-related bloodstream infection ）は　0.50/ 1000カテーテル日数で、介入前は 3.20/1000カテーテル日数で、同様のほかのＩＣＵでは 5.03 / 1000 カテーテル日数 (P = .001)


c.f. Central Venous Catheter Insertion and Maintenance Vanderbilt Medical Center

Central Venous Catheterization — Subclavian Vein NEJM Vol. 357;e26 Ｄｅｃ．　13 2007


低医療報酬のため、このような器具がつかえないという問題は・・・