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Effectiveness of Simulation-Based Training on Critical Care Nurses' Competency in Infection Prevention: A Systematic
Ja'far M Alkhawaldeh1,2, Dalal Yehia1, Ola A Kutah1
1Faculty of Nursing, Isra University, Amman, Jordan.
Background:
Healthcare-associated infections (HAIs) are a persistent problem in intensive care units, contributing to morbidity, mortality and increased healthcare costs. Nurses are central to infection prevention, yet traditional education often fails to ensure sustained competence. SBT has been introduced as a promising strategy, though its overall effectiveness remains underexplored.
Aim:
This systematic review evaluated the effectiveness of simulation-based training (SBT) in enhancing infection-prevention competencies among critical care nurses.
Study Design:
Following PRISMA 2020 guidelines, randomised controlled trials (RCTs) published between 2011 and 2025 were systematically reviewed. Searches were conducted across eight databases: CINAHL, PubMed, MEDLINE, ProQuest, EBSCO, Scopus, ScienceDirect and SAGE Journals. Study quality was assessed using the CONSORT checklist, and the risk of bias was evaluated with the Cochrane RoB 2 tool. Data on study characteristics, interventions, outcomes and limitations were extracted.
Results:
Ten RCTs met the inclusion criteria. Interventions included high-fidelity simulations, scenario-based instruction and virtual reality modules. Across studies, SBT consistently improved nurses' knowledge, procedural skills, self-efficacy and adherence to infection-prevention bundles. However, evidence for sustained behavioural change-particularly long-term hand hygiene compliance-and direct reductions in infection rates was mixed. Considerable heterogeneity in intervention design, sample size and follow-up periods limited comparability.
Conclusions:
SBT is effective in enhancing critical care nurses' knowledge and skill competencies in infection prevention. Sustained behavioural improvements, however, require reinforcement and multimodal strategies.
Relevance To Clinical Practice:
Structured SBT should be integrated into infection-prevention education to strengthen nursing competence, reduce HAIs and improve patient outcomes. Repeated, context-specific interventions are recommended.
Review Registration:
PROSPERO Protocol registration ID: 1134226.
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