Discussion

SBT is underutilized in infection prevention, but it can serve as an important adjunct to traditional educational tools. It can target learners ranging from students to nurses, physicians, and other ancillary staff. SBT programs in infection prevention can vary widely from disaster preparedness of high acuity to low-frequency clinical scenarios to day-to-day infection prevention measures. SBT can improve learner’s sense of competence and confidence, ^{Reference Abrahamson, Canzian and Brunet11–Reference Carvalho, Castro and Leon13} increase patient safety through improved compliance in infection prevention measures ^{Reference Mittal, Morris and Kelz16,Reference Cartier, Inan and Zingg22–Reference Sherertz, Ely and Westbrook26,Reference Hebbar, Cunningham and McCracken28,Reference Vanylos, Peto and Viszlai32} and increase in knowledge, ^{Reference Rosenberg, Terhaar and Ascenzi29,Reference Jansson, Syrjala and Ohtonen33} improve HAI rates, ^{Reference Barnum, Tatebe and Halverson15,Reference Allen, MIller and Nicholas17–Reference Barsuk, Cohen and Feinglass20} and reduce healthcare costs.Reference Cohen, Feinglass and Barsuk ²¹

Simulation modalities can offer a realistic imitation under test conditions. Different simulation modalities and environments are classified as low fidelity, medium fidelity, and high fidelity, with the highest fidelity modality or environment most accurately representing the real environment. Various simulation modalities have been integrated into infection prevention efforts, each with its own advantages and disadvantages (Table 2). Task trainers (low-fidelity simulators) have been predominantly utilized to help learners practice specific psychomotor skills such as aseptic technique in the insertion of central venous catheters ^{Reference Allen, MIller and Nicholas17–Reference Sherertz, Ely and Westbrook26} and indwelling urinary catheters. ^{Reference Barnum, Tatebe and Halverson15,Reference Mittal, Morris and Kelz16} Standardized patients, which are real people portraying the role of patients, have been utilized to practice standard precautions and interpersonal skills. ^{Reference Kim, Kim and Kim10} Virtual reality (high fidelity) has also taught healthcare personnel to safely don and doff PPE, ^{Reference Ragazzoni, Ingrassia and Echeverri34} as virtual reality help learners to gain knowledge on the proper process of a procedure in a scalable fashion. In prior outbreaks, mid- and high-fidelity manikins, which are full-body manikins, were utilized to mimic patient encounters with rare communicable diseases like Ebola and SARS, aiding in the identification of errors in infection control measures. ^{Reference Abrahamson, Canzian and Brunet11–Reference Carvalho, Castro and Leon13} These simulators can replicate a patient’s physiology modeling through the programming of vitals, breathing, or other patient presentations. They enable a team to work collectively to deliver care (eg, intensive care unit setting with in full hazmat suit) while performing a certain set of procedural tasks (eg, intubation) in a physical environment. This enables teams to practice not only individual skills, but also critical teamwork and communication skills.

Table 2. Simulation Modalities

Ultimately, simulation experts match the learning objectives to the most effective modality. For effective learning, SBT should be offered as part of a curriculum to supplement and complement other educational methods with clearly defined objectives and benchmarks for learners to achieve. The program should provide individualized and team learning and should allow for repetitive practice with clinical variation such as varying levels of difficulty if feasible. Expert trained facilitators should provide feedback during or after a learning experience through rapid cycle deliberate practice or debriefing, based on learning objectives. ^{Reference Al-Elq35}

SBT in infection prevention has predominantly focused on central venous catheter insertion and maintenance with various studies reporting significant improvement in compliance with sterile techniques and decrease in CLABSI rate. ^{Reference Allen, MIller and Nicholas17–Reference Scholtz, Manoachino and Nishisaki30} However, despite its proven effectiveness in CLABSI prevention, SBT has remained underutilized in other realms of infection prevention. Through repetitive and deliberate practice to develop procedural competence and immediate constructive debriefing by an expertly trained debriefer, SBT can allow for standardization of routine infection prevention measures and proper implementation of evidence-based prevention strategies to reduce HAI rates. In addition, SBT can play a role in understanding and optimizing workflows and bottlenecks in high-acuity, low-frequency encounters for disaster preparedness. Centralized SBT that promotes competency-based education can yield a large return on investment by reducing overall healthcare costs through improved quality of care, reduced HAI penalties, mitigation of readmissions, and decreased lengths of stay. ^{Reference Cohen, Feinglass and Barsuk21} This study demonstrates the benefits of SBT in an expanded role in infection prevention teaching and argues for continued innovation.

In summary, SBT is underutilized in infection prevention but can serve as a crucial educational tool. The coronavirus disease 2019 (COVID-19) pandemic has exposed our inadequacy in infection prevention training as healthcare personnel train on the job in high-risk clinical environments. SBT can bridge this gap and improve compliance with infection prevention measures through repeated education in standardized teaching sessions in a safe environment by reinforcing best practices and personal accountability.