Escape room simulation promotes infection control adherence at the temple VA

Designed initially for entertainment purposes, escape rooms are proving their value as medical training tools as demonstrated by the Central Texas Veterans Health Care System. Staff there have used the concept for a flu pandemic escape room and is reporting increased staff handwashing and acceptance of flu vaccines as a result.

The escape room is the brainchild of Gracia Boseman, RN, MPH, and Kristy Causey, MSN, RN, who are presenting their findings today at the Association for Professionals in Infection Control and Epidemiology's (APIC's), 48th Annual Conference, being held virtually.

In 2017, Boseman and Causey aimed to boost staff attendance, especially among non-clinical staff, of voluntary infection prevention and control education at the health care system, which includes hospitals and clinics surrounding Austin, Waco, and Temple. Seizing on the popularity of The Walking Dead and the fact it was almost Halloween, the team hit upon the idea for a zombie-themed High Consequence Infectious Disease (HCID) escape room to entice staff into the sessions.

Not only was their escape room a runaway hit, but the concept proved to be prescient as it preceded the coronavirus pandemic by three years.

"The escape room was successful beyond our wildest expectations," said Boseman, who added that self-reported behavioral changes among participants include an increase in handwashing by 61% and personal protective equipment (PPE) use by 21%. "Staff also became acutely aware that contaminated surfaces play a role in disease transmission as they carry viruses and bacteria, and the importance of wearing PPE—knowledge that would prove invaluable during the COVID-19 pandemic."

Participants were given a pandemic, novel flu scenario and asked to select appropriate PPE prior to entering the room. Once inside, participants had to work as a team to find all the clues in the short amount of time.

"The more senses we engage, the more people learn and the higher the level of retention, so we designed a hands-on, immersive training environment," explained Causey. "We set up different types of specimen collection kits including viral transport medium and bacterial swabs, and participants had to pick the correct swab. We also placed whitening laundry detergent on surfaces to show where germs were and how they transfer from one surface to the other."

Attendance at voluntary education increased from an average of 20 clinical attendees per training to 189 clinical and non-clinical attendees. Non-clinical staff included clerks, facilities and engineering staff, and environmental services workers. The team reported employee lines before they opened, took walk-ins during their lunch breaks, outfitted a bus to take the escape room to outlying clinics, and repeated the escape room for infection prevention training in 2018 and 2019.

Planned trainings for 2020 were cancelled due to COVID. However, during the COVID-19 pandemic, Boseman and Causey noted that hospital employees who had attended the trainings were more actively engaged in preparation for the pandemic. Ultimately, the Central Texas Veterans Health Care System trained more than 1,100 employees over three years using the escape room.

"Engaging healthcare staff in the basics of infection prevention and control is a cornerstone of patient safety," said 2021 APIC President Ann Marie Pettis, BSN, RN, CIC, FAPIC. "This team proves that when learning is fun, we can achieve better health outcomes, and that's a win for everyone."

The Central Texas Veterans Healthcare System has provided consultative input to a half-dozen other Veteran health care systems interested in replicating the escape room as part of their infection prevention training and other simulation training.