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Yoshikawa A, Ohtsuka H, Aoki K, Tashiro N, Togo S, Komaba K, Nogawa S, Osawa M, Enokida M. Simulation-based infection prevention and control training for medical and healthcare students: a systematic review. Front Med (Lausanne) 2025; 12:1529557. [PMID: 40438369 PMCID: PMC12116496 DOI: 10.3389/fmed.2025.1529557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2024] [Accepted: 04/29/2025] [Indexed: 06/01/2025] Open
Abstract
Introduction Infection prevention and control education has traditionally been conducted in a lecture-based manner, and simulation-based educational strategies have become increasingly prevalent in the field of medical education in recent years. This systematic review aimed to compare the effectiveness of the simulation-based and traditional strategies of infection prevention and control education and to show the differences between these educational approaches. Furthermore, we identified the characteristics of simulation-based strategies for infection prevention and control education. Method Systematic reviews and meta-analyses were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was conducted using the CENTRAL, MEDLINE, and Scopus databases for articles published between January 1990 and September 2022. This study focused on students enrolled in medical and health professional courses. As such, healthcare professionals already working in clinical settings, as well as kindergarten and elementary school students were excluded from the study. The quality of the included studies and the risk of bias in each study were assessed. A total of 254 articles were identified; 21 underwent secondary screening. Ultimately, 10 articles were selected for the final review. Results Educational strategies between simulation- and lecture-based education showed improvements in knowledge acquisition. There was no significant difference in the rate of improvement between the two educational strategies. The characteristics of simulation-based educational strategies included confidence in skill performance, decision-making and problem-solving skills, emotional aspects related to infectious diseases (such as fear, empathy, self-reflection, and integration of complex information), and student satisfaction. Conclusion This systematic review suggests that simulation-based education is effective in developing students' skills and attitudes, while traditional lecture-based methods are more suited for reinforcing students' knowledge. Therefore, it is essential to choose educational strategies based on specific learning objectives and outcomes. Systematic review registration This systematic review protocol was preregistered in the Open Science Framework: https://osf.io/uj623/.
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Affiliation(s)
- Akira Yoshikawa
- Division of Morphology, Anatomy and Physiology, Department of Medical Basics, Specialty and Education, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Hiroyuki Ohtsuka
- Division of Neurological Science, Department of Rehabilitation, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Keiichiro Aoki
- Division of Occupational Therapy and Mental Health, Department of Rehabilitation, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Naonori Tashiro
- Division of Cardiopulmonary Rehabilitation Science, Department of Rehabilitation, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Shusuke Togo
- Division of Healthcare Management, Department of Medical Basics, Specialty and Education, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Kazuki Komaba
- Division of Cardiopulmonary Rehabilitation Science, Department of Rehabilitation, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Satoshi Nogawa
- Division of Clinical Engineering, Department of Medical Technology, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Miwa Osawa
- Division of Clinical Radiology, Department of Medical Technology, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
| | - Megumi Enokida
- Division of Health Science Education, Department of Medical Basics, Specialty and Education, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Yokohama, Japan
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Pacis M, Azor-Ocampo A, Burnett E, Tanasapphaisal C, Coleman B. Prophylactic Dressings for Maintaining Skin Integrity of Healthcare Workers When Using N95 Respirators While Preventing Contamination Due to the Novel Coronavirus: A Quality Improvement Project. J Wound Ostomy Continence Nurs 2020; 47:551-557. [PMID: 33201140 PMCID: PMC7678667 DOI: 10.1097/won.0000000000000713] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Extended use of N95 respirator masks is far more prevalent during the coronavirus disease 2019 (COVID-19) pandemic. As WOC nurses, we were tasked with formulating procedures for protecting the facial skin integrity of healthcare workers (HCWs) using personal protective devices when caring for patients with suspected or active COVID-19, while avoiding contamination when the masks are donned or doffed. This quality improvement project describes how we approached this project within the limited time frame available as we cared for patients with established and suspected COVID-19. PARTICIPANTS AND SETTING This project focused on HCW use of N95 respirator masks and dressings currently available in our facility. The 4 WOC nurses acted as quality improvement project directors and as participants. The setting for our project was our facility's simulation laboratory. APPROACH We evaluated 6 topical products (an alcohol-free liquid acrylate, thin film dressing, thin hydrocolloid dressing, hydrocolloid blister care cushion, thin foam transfer dressing, and thick foam dressing) applied to skin in contact with 3 N95 respirators; all are available on our facility's formulary and all are in widespread clinical use. After the product was applied to the face and nose, the N95 respirator was donned and evaluated for fit. Participants then wore the devices for 10 hours and doffed the mask using established facility procedures. In order to evaluate for potential contamination including possible aerosolization, we applied a commercially available fluorescent lotion to simulate the presence of infectious particles. Contamination was assessed using an ultraviolet light for all dressings except for the alcohol-free liquid acrylate. We also evaluated cutaneous responses (skin integrity, irritation, comfort) during this period. OUTCOMES We found that contamination of the simulated pathogen did not occur with removal of any of the protective products. No skin irritation was noted with any of the tested products after a 10-hour wear time underneath the N95 respirator masks, but mild discomfort was experienced with 3 of the dressings (thin film dressing and both hydrocolloid dressings). CONCLUSION Based on these experiences, we recommend application of an alcohol-free liquid acrylate film to prevent facial skin injury associated with friction from the extended use of an N95 respirator mask. We further recommend performing a fit test and user-performed seal check with the use of any topical dressing and especially those that add cushion. For the duration of the COVID-19 pandemic, we recommend use of protective dressings to maintain skin integrity and protection from coronavirus infection as HCWs continue to provide care to all of patients under their care.
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Affiliation(s)
- Michelle Pacis
- Correspondences: Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, 8700 Beverly Blvd, NT Ste 3060, Los Angeles, CA 90048 () or Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, 8700 Beverly Blvd, NT Ste 3060, Los Angeles, CA 90048 ()
| | - Annielyn Azor-Ocampo
- Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Emily Burnett
- Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chutiwan Tanasapphaisal
- Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Bernice Coleman
- Michelle Pacis, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Annielyn Azor-Ocampo, MSN, RN, CWOCN, DAPWCA, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Emily Burnett, MSN, RN, CNL, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Chutiwan Tanasapphaisal, BSN, RN, CWOCN, Department of Wound, Ostomy and Continence, Cedars-Sinai Medical Center, Los Angeles, California
- Bernice Coleman, PhD, ACNP-BC, FAHA, FAAN, Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
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Herepath A, Kitchener M, Waring J. A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrea Herepath
- Sir Roland Smith Centre for Strategic Management, Department of Entrepreneurship, Strategy and Innovation, Lancaster University Management School, Lancaster University, Lancaster, UK
- Cardiff Business School, Cardiff University, Cardiff, UK
| | | | - Justin Waring
- Nottingham University Business School, University of Nottingham, Nottingham, UK
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Yang RL, Reinke CE, Mittal MK, Kean CR, Diaz E, Fishman NO, Morris JB, Kelz RR. The surgery clerkship: an opportunity for preclinical credentialing in urinary catheterization. Am J Surg 2012; 204:535-9. [PMID: 22591699 DOI: 10.1016/j.amjsurg.2012.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND At our hospital, medical students lost privileges to perform urinary catheterization because of concern regarding catheter-associated urinary tract infections. We hypothesized that trained medical students could perform urinary catheterization with the same proficiency as licensed practitioners. METHODS Medical students completed a credentialing program in urinary catheterization. Prospectively, the rate of catheter-associated urinary tract infections after urinary catheterization performed by medical students was compared with the health system-wide rate of catheter-associated urinary tract infections after urinary catheterization performed by non-medical students using an incidence rate ratio (IRR). RESULTS Over 9 months, a total of 432 and 55,401 catheter days accrued in patients who underwent urinary catheterization by medial students and non-medical students, resulting in 1 and 129 catheter-associated urinary tract infections, respectively. The incidence rate of catheter-associated urinary tract infections per 1,000 catheter days was 2.31 in the medical student-placed catheters and 2.33 in the non-MS-placed catheters (IRR = .99, P = .55). CONCLUSIONS Preclinical credentialing in urinary catheterization resulted in the reinstatement of urinary catheterization privileges to qualified medical students. Student proficiency in urinary catheterization can match that of licensed practitioners.
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Affiliation(s)
- Rachel L Yang
- Department of Surgery, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA
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