UCLA

Background. Effective educational delivery requires that nursing professional development (NPD) practitioners engage registered nurses (RNs) to address rising healthcare-associated infections (HAIs). Four percent of patients in the U.S. and 10% worldwide are diagnosed with an infection while in the hospital. HAIs have increased during the COVID pandemic despite current infection prevention control practices and educational approaches. C’difficile costs range from $11,000-17,260 per case. Health system patient data at the study site illustrated C’difficile infection rates higher than the benchmark, with 26 units underperforming when compared to the standardized infection ratio (SIR) or <1 goal. Gaps in the literature illustrated inconsistent links in education to practice.

Aims. The following research questions were explored: In a large academic health system setting, does virtual reality simulation (VRS) compared to traditional education (TE) improve RN knowledge and behavior; as well as, C’difficile rates? Is there a return on investment (ROI) for these approaches? Aims 1-2 tested the effect of the delivery format on knowledge and behavior. Aim 3 compared C’difficile rates after delivering the two educational modalities. Aim 4 explored ROI of the two educational methods.

Methods. An experimental randomized controlled trial (RCT) design with two groups was used to answer the research questions. One pair of matched inpatient units was randomly selected for participation, assigned to either the VRS or TE group. Instruments used included the Cognitive, Affective, and Psychomotor Perceived (CAP) Learning Scale and a researcher-developed knowledge assessment and clinical behavior scoring tool. Data were analyzed using t-tests, multiple regression, the Poisson distribution, and financial equations.

Results. Eighty-four medical-surgical RNs participated in the study (n=44 VRS, n=40 TE). No statistically significant differences between groups were found. There was no significant differences (t=1.4, p =.16) for change in mean knowledge between groups (Cohen’s d=.3) or change in mean behavior (t=.67, p =.5) between groups (Cohen’s d =.15). Statistical significance was found in regression analysis when considering pre-intervention scores. The TE group had no statistically significant C’difficile rate differences between 1-month pre-intervention to 1-month post-intervention. The VRS group had significantly lower rates for these intervals (p =.0003). C’difficile rates were significantly lower for both groups for the 3-month post intervention period as compared to the 10-month period pre-intervention. Financial analysis showed a ROI for both modalities, with VRS having higher yields over time.

Conclusions. Both VRS and TE modalities reduced C’difficile rates and produced positive economic returns on investment to inform future resource allocation.