The Impact of Procedural Checklist Competency Requirements on Early Chest Port Infections

Background: The purpose of our study was to assess resident and fellow patient care competency related to chest port catheter insertion after implementation of an educational program and completion of a certification checklist. Furthermore, we aimed to measure the impact of this intervention on early infection rates. Methods: Baseline early infection rates as defined by the CDC were obtained in 152 consecutive patients. These were segregated by primary operator and timeframe. Following establishment of a baseline infection rate, formalized training of residents and fellows was undertaken. This included a hands-on suture workshop and satisfactory completion of a skill set with attending level certification. To evaluate competency, a procedure competency checklist was developed by the interventional radiology faculty. The checklist consisted of 17 detailed steps considered important for chest port catheter insertion. Following the training period, infection rates of 415 consecutive patients were calculated and compared to the baseline infection rates. Results: Four out of eight (50%) residents satisfactorily demonstrated competency and were certified as primary operators for port insertion. In addition, both of the two interventional radiology fellows were certified. The early infection rates of chest port catheters placed by residents slightly decreased from 3.0% to 2.2% following the intervention compared to baseline, although this decrease was not statistically significant. Total infection rates also decreased slightly from 2.6% to 1.4%. Conclusions: In our study, the rate of early infections after port insertion decreased following the educational intervention and certification process, although this was not statistically significant.