Low-cost e-Learning Can Help Prevent High-cost HAIs


Healthcare-associated infections (HAIs) can have dramatic effects on excess morbidity and associated costs and so finding effective and efficient way to prevent them is important.

Healthcare-associated infections (HAIs), particularly ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI), surgical site infection (SSI), and catheter-related urinary tract infection (CAUTI),1 are not uncommon in patients in acute-care hospitals who are admitted to the intensive care unit.2 However, because HAIs can have dramatic effects on excess morbidity and associated costs, they must be controlled to the fullest extent possible in these settings.

Although the results of several studies have indicated that compliance with current evidence-based guidelines could result in the prevention of the majority of all CLABSI, CAUTI, VAP, and SSI cases,3-5 adherence rates and levels of guideline knowledge among healthcare workers (HCWs) are often low.6-11 Therefore, attempts to increase HCW awareness and knowledge of effective, evidence-based guideline recommendations for preventing and reducing HAIs are paramount.

One of the potential methods used to raise awareness and promote learning amongst HCWs is referred to as electronic (e)-learning, which is delivered through the internet. Sonia O. Labeau, PhD, a member of the Faculty of Education, Health and Social Work at the University College Ghent and the Faculty of Medicine and Health Sciences at Ghent University in Belgium, and her colleagues on the EVIDENCE Research Team developed and tested the effects of an evidence-based HAI prevention e-learning-course to improve guideline awareness among an international cohort of HCWs. The study report was published recently in Infection Control & Hospital Epidemiology.12

The e-learning course used in the study was developed as seven chapters that included information on evidence-based practice, the problem of HAIs and the importance of prevention, the role of hand hygiene in prevention, and one chapter each for the four most common HAIs. The validity of the course content was assessed and approved by five of the co-authors, who served as an international team of experts in infection prevention. The study sample used to test the effectiveness of the e-learning program consisted of a cohort of international voluntary learners recruited through repeated international promotional campaigns.

Participants completed a multiple-choice knowledge test (MCT) (pretest; T0) to measure prior knowledge, had eight weeks to finish the e-learning course, completed a second 50-item MCT (posttest1; T1) to measure an immediate learning effect, and completed a third 50-item MCT (T2) to measure residual learning effects. The questions in T0, T1, and T2 were identical but ranked differently in each test. Of the 3,587 HCWs representing 79 nationalities enrolled, 1,011 HCWs (28.2%) completed both T1 and T2.

The study results revealed a median study time of 193 minutes, which was very close to that (200 minutes) associated with the maximum immediate learning effect (28%); however, study times >300 minutes resulted in the highest residual effect (24%). Median scores for T0 (52%), T1 (80%), and T2 (74%) suggested a large increase in learning between the pretest and the first posttest, and a good level of retention between the first and second posttests. Both the overall immediate learning effect of 24% (T0 vs. T1) and the overall residual learning effect of 18% (T0 vs. T2) reached the level of statistical significance (P<.001). It should be noted, however, that this study had a rather high drop-out rate, such that <40% of all enrolled HCWs actually studied the course. A drop-out survey revealed that lack of time was the primary reason reported.

In a summation of their results, the investigators stated, "... our study suggests that moderate time invested in a low-cost e-course with good usability features and exercises for self-evaluation can enhance knowledge on HAI prevention." Additionally, Dr. Labeau and colleagues alluded to the broader implications of their work by stating, "We therefore encourage institutional decision makers and professional societies to consider translating their recommendations in e-learning modules in parallel with published guidelines." The apparent success of this strategy coupled with its low cost of implementation make it an attractive option for improving HCW knowledge and subsequent performance, ideally leading to better outcomes for hospitalized patients.

William Perlman, PhD, CMPP is a former research scientist currently working as a medical/scientific content development specialist. He earned his BA in Psychology from Johns Hopkins University, his PhD in Neuroscience at UCLA, and completed three years of postdoctoral fellowship in the Neuropathology Section of the Clinical Brain Disorders Branch of the National Institute of Mental Health.


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