Impact of Serious Games Based Training in Reduction of Nosocomial Infections

Hospital Acquired Infections (HAIs) or nosocomial infections are complex to treat and are a
growing global burden. HAIs affect about one in 25 patients in the US and situation is worse
in resource-poor nations. A prevalence survey conducted under WHO in 55 hospitals of 14
countries showed that ~8.7% of in-patients had HAIs. At any time, over 1.4 million people
worldwide suffer from infectious complications acquired in hospital. HAIs contributes to
increased economic burden, negatively affecting quality of life and deaths. 1,2

As per the existing methodologies direct observation is the gold standard to monitor
compliance and to prevent or reduce HAIs. Frequent surveys, interviews and inspections are
the other commonest methods implemented as prevention of HAIs. Indirect monitoring
involves automated monitoring systems (video monitoring , real time location systems)
monitoring hand hygiene product consumption). Hospitals with sophisticated information
systems are in a position to streamline surveillance process through computer-based algorithms
that identifies patients at highest risk of HAI.3 4 Computerized surveillance helps in better
implementation of preventive strategies, but lower infection rates have not been proven
conclusively.

Conventional training methodologies have not proved to be significantly impactful in
knowledge retention and message recall. A newer approach called Gamification is a positive
and effective method to change behaviour. It can engage, motivate and influence people. It is
a concept that has unknowingly been applied for years though the term was widely used only
after 2010. A ‘serious game’ is defined as an ‘interactive computer application, with or without
significant hardware component, that has a challenging goal, is fun to play and engaging,
incorporates some scoring mechanism, and supplies the user with skills, knowledge or attitudes
useful in reality.

A hand hygiene improvement campaign in Edinburgh Royal Infirmary (Scotland, UK) using
the SureWash gesture recognition system (SureWash, IRL) which concluded that the senior
staff noted a change in hand hygiene culture following the campaign and the good-natured
competition between staff to demonstrate hand hygiene competence using the SureWash
serious game. Another study conducted in Portugal wherein gamification was selected as the
solution (Osyrish) to the compliance problem to engage and motivate people to achieve specific
goals.An innovative indoor system, based on Beacons (iBeaconTM), was used to collect data on
nurses which concluded that it was opportunity to improve the performance by nurses.6

Mediknit (A HealthConnect Digital Inititative) has developed a serious game and micro-
learning training methodology for coaching healthcare practitioners on Hand Hygeine,

Immunisation Safety, Injection Safety and other aspects of infection prevention and control.
These modules are first of it’s kind in the world for mixed pedagogy, knowledge mapping
techniques and is implemented as a proof of concept at the Singapore General Hospital. Initial
survey showed that >95% of nurses felt this to be significantly better than conventional
classroom based trainings and overall ~3-10% reduction HAIs was reported. Study is still
ongoing.

Whilst there is growing interest in using serious games in health as valuable adjunct to
conventional education, training and behaviour change interventions, due to the immaturity of
the field, implementing this method still remains as a challenge and methodological aspects
can generally be much improved to see a positive response in the upcoming years.

References
1. Tikhomirov E. WHO Programme for the Control of Hospital Infections.
Chemiotherapia, 1987, 3:148– 151.
2. Mayon-White RT et al. An international survey of the prevalence of hospital-acquired
infection. J Hosp Infect, 1988, 11 (Supplement A):43–48.
3. Boughton B. Computerized infection monitoring and rapid control measures benefit
patients and hospitals. From Medscape Medical News.
4. Considerations for a WHO European strategy on health-care-associated infection,
surveillance, and control.
5. Graafland M, Schraagen JM, Schijven MP. Systematic review of serious games for
medical education and surgical skills training. Br J Surg. 2012;99:1322–30

6. Lapao LV, Marques R, Gregorio J, Mira-da-Silva M. Nurses’ self-improvement hand-
hygiene compliance in a hospital ward: combining indoor location with gamification

data presentation. Antimicrobial resistance and infection control. 2015 Dec
1;4(S1):I11.

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