This study was approved by the institutional review boards at each study site. Five hospitals in the United States participated in the study. Each participating site identified a minimum of 20 clinicians who placed central venous catheters (CVCs) to take the training course described below. The 5 hospitals integrated the course into hospital-specific training activities targeted at those clinicians who might perform or assist in CVC placement. Study participants were registered nurses, nurse practitioners, physician assistants, residents, fellows, and attending physicians from hospital medicine, critical-care medicine, surgery, and radiology departments. Data were collected electronically via the training course’s assessment tool.
The self-paced course, which provided video demonstration of common errors, aimed to educate clinicians in (a) outcomes and morbidity of CLABSIs and (b) methods to prevent CLABSIs. The content of the course was based on published systematic reviews.1
The course was pilot tested previously in a prospective, randomized, controlled study in the admitting department of a university-based high-volume trauma center.4
In the pilot study, residents who had completed the CVC training course were significantly more likely to comply with sterile practices than were residents who took a paper-based training course or those who had not taken the training course (P
The CVC Knowledge and Attitude Questionnaire (CVCKAQ) was developed (see ) to assess knowledge on outcomes and morbidity of CLABSIs and methods to prevent CLABSIs (multiple-choice questions 1–17). Attitude toward sterile practices was assessed using the construct from the theory of planned behavior (Likert-scale questions 18–22), which asserts that people act according to their intentions and perceptions of command over the behavior, and their intentions are inspired by attitudes toward the behavior, subjective norms, and perceived behavioral control.5
FIGURE 1 Central venous catheter (CVC) knowledge and attitude questionnaire. INR, international normalized ratio; PT, prothrombin time; PTT, partial thromboblastin time. Bolded text indicates the “correct” answers. Attitude questions (18–22) (more ...)
The questionnaire was piloted in April 2008 on 10 residents at 1 participating institution and revised on the basis of the results and feedback from the residents. The revised version was piloted in a different participating institution but the questionnaire reliability was not specifically tested. The CVCKAQ was administered 3 times: (1) as a pretest, before the course, (2) as a posttest, immediately after the course, and (3) as a follow-up test, 3–4 months after course completion. The CVCKAQ was completed electronically. A dedicated course Web portal was used at each site (each at a different city) to reduce potential cross-influence among sites. Each participant was assigned a unique anonymous sign-in to allow within-subject comparison of test scores from the pretests, the posttests, and the follow-up tests while protecting anonymity.
Linear mixed models were used to analyze the change in test scores (posttraining minus pretraining). The models included random intercepts to account for within-subject and within-site correlation. Linear mixed models with random intercepts were also used to assess whether subjective norms of CVC infection prevention related to test scores. The statistical software R was used for analysis.6