Patient safety and infection control: bases for curricular integration

Integrative review, designed to answer the question: “How does curricular integration of content about ‘patient safety teaching’ and content about ‘infection prevention and control practices’ occur in undergraduate courses in the health field?”. The following databases were searched for primary studies: CINAHL, LILACS, ScienceDirect, Web of Science, Scopus, Europe PMC and MEDLINE.

Results:

The final sample consisted of 13 studies. After content analysis, primary studies were grouped into two subject categories: “Innovative teaching practices” and “Curricular evaluation.

Conclusion:

Patient safety related to infection prevention and control practices is present in the curriculum of health undergraduate courses, but is not coordinated with other themes, is taught sporadically, and focuses mainly on hand hygiene.

Descriptors:
Patient Safety; Teaching; Infection; Curriculum; Higher Education

Database (total)	Cruzamento - Descritores	Number of papers
CINAHL (8)	"Patient Safety" AND "Education, Graduate" AND Curriculum AND "Nosocomial Infection"	-
	"Patient Safety" AND "Education, Graduate" AND Curriculum	-
	"Patient Safety" AND "Education, Graduate" AND "Nosocomial Infection"	-
	"Patient Safety" AND "Education, Graduate"	7
	"Patient Safety" AND Curriculum AND "Nosocomial Infection"	1
LILACS (3)	"Segurança do Paciente" [Palavras] AND "Educação Superior" [Palavras]	-
LILACS (3)	"Segurança do Paciente" [Palavras] AND "currículo" [Palavras]	3
PubMed (19)	"Patient Safety" AND "Education, Graduate" AND Curriculum AND "Nosocomial Infection"	-
	"Patient Safety" AND "Education, Graduate" AND "Nosocomial Infection"	-
	"Patient Safety" AND "Education, Graduate" AND Curriculum"	-
	"Patient Safety" AND Curriculum AND "Nosocomial Infection"	19
Web of Science (129)	"Patient Safety" AND "Education, Graduate" AND "Curriculum" AND "Nosocomial Infection"	-
	Patient Safety * Education, Graduate * Nosocomial Infection	-
	"Patient Safety" AND Curriculum AND "Nosocomial Infection"	1
	Patient Safety * Education, Graduate * Curriculum	128
Scopus (76)	"Patient Safety" AND "Education, Graduate" AND Curriculum AND "Nosocomial Infection"	1
Scopus (76)	"Patient Safety" AND "Education, Graduate" AND "Nosocomial Infection"	2
	"Patient Safety" AND "Education, Graduate" AND curriculum	30
	"Patient Safety" AND Curriculum AND "Nosocomial Infection"	43
Europe PMC (167)	"Patient Safety" AND ("Education, Graduate" OR Curriculum) AND "Nosocomial Infection"	10
	"Patient Safety" AND Curriculum AND "Nosocomial Infection"	123
	"Patient Safety" AND "Education, Graduate" AND Curriculum" "Patient Safety" AND "Education, Graduate" AND "Nosocomial Infection" Patient Safety" AND "Nosocomial Infection" AND ("Education, Graduate" OR Higher Education" OR Curriculum)	21 1 12
Science Direct (3)	("Patient Safety"[Mesh]) AND "Education, Graduate"[Mesh]) AND "Curriculum"[Mesh]) AND "Nosocomial Infection"[Mesh]	1
	("Patient Safety"[Mesh]) AND "Education, Graduate"[Mesh]) AND "Nosocomial Infection"[Mesh]	-
	("Curriculum"[Mesh]) AND "Patient Safety"[Mesh]) AND "Nosocomial Infection"[Mesh]	2
Total		405

Title/Subject category	Database/year	Design	Interventions	Outcomes
Innovative teaching practices
Compliance of nursing students with infection prevention precautions: effectiveness of a teaching program⁽¹¹11 Al-Hussami M, Darawad M. Compliance of nursing students with infection prevention precautions: effectiveness of a teaching program. Am J Infect Control [Internet]. 2013 [cited 2017 Mar 17]; 41(4):332-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23036481 https://www.ncbi.nlm.nih.gov/pubmed/2303... ⁾	Scopus 2013	Clinical trial	To test the efficacy of an educational program to teach nursing students about infection prevention.	The program was effective, given that the experimental group presented a significant improvement in scores related to knowledge and attitude. The program was a promising tool for infection prevention and control.
Limited knowledge and practice of Chinese medical students regarding healthcare-associated infections⁽¹²12 Huang Y, Xie W, Zeng J, Law F, Ba-Thein W. Limited knowledge and practice of Chinese medical students regarding health-care associated infections. J Infect Dev Ctries [Internet]. 2013; [cited 2016 Dec 14]; 7:144-51. Available from: http://jidc.org/index.php/journal/article/view/23416661/832 http://jidc.org/index.php/journal/articl... ⁾	Scopus 2013	Descriptive study	To examine if the clinical skills and performance of the students were influenced by teaching resources used to instruct them about infection control in the healthcare field.	Significant deficiencies in teaching resources may limit the knowledge and performance of students in important infection prevention and control practices, especially hand hygiene, the use of personal protective equipment, and the identification of pathogenic microorganisms. It is recommended that the content be spread out over the course and the teaching strategies be reviewed to focus on more inclusive and dynamic classes.
An interdisciplinary infection control education intervention: necessary but not sufficient⁽¹³13 Wagner DP, Parker CJ, Mavis BE, Smith MK. An interdisciplinary infection control education intervention: necessary but not sufficient. J Grad Med Educ [Internet]. 2011 [cited 2016 Dec 14]; 3(2):203-10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3184921/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Europe PMC 2011	Prospective cohort study	To evaluate the efficacy of a module to teach infection control to nursing and medical students.	The use of the module was an effective and useful learning experience for developing attitudes and skills in clinical practices oriented to infection control. The tool was well accepted and contributed to knowledge retention during the monitoring of the participants, which lasted five months.
Creating a common patient safety denominator: the interns' course⁽¹⁴14 Shekhter I, Nevo I, Fitzpatrick M, Everett-Thomas R, Sanko JS, Birnbach DJ. Creating a common patient safety denominator: the Interns’ Course. J Grad Med Educ [Internet]. 2009 [cited 2016 Dec 14]; 1(2):269-72. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931250/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Europe PMC 2009	Prospective cohort study	To develop a "simulation scenario" for the evaluation of the performance of medical students in prevention of mistakes related to communication, teamwork and adherence to hand hygiene through the application of specific indicators.	The study reported serious inconsistencies in the students' performance regarding observation of hand hygiene, teamwork and, mainly, communication during shift changes. Participants said that the use of simulation scenarios allowed the identification of individual limitations and curriculum deficiencies that might compromise their clinical practice.
Educational interventions to improve knowledge and skills of interns about prevention and control of hospital-associated infections⁽¹⁵15 Dogra S, Mahsjan R, Jad B. Educational interventions to improve knowledge and skills of interns towards prevention and control of hospital-associated infections. Int J Appl Basic Med Res [Internet]. 2016 [cited 2017 Mar 19]; 5(1):54-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4552068/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Europe PMC 2015	Prospective cohort study	To identify the educational deficit in the curriculum of medical undergraduate courses regarding prevention and control of healthcare-related infections.	In the current medical curriculum, the topic is taught by didactic lectures about facts related to etiology, pathogenesis and control measures. There is no module dedicated to the practical training of students to teach them hand washing skills and waste elimination, nor is there any method to assess those skills. The evaluation of knowledge of HAIs is a matter of chance, and practical skills are not assessed. The study revealed improvement in the knowledge and skills of the participants.
Comprehension of undergraduate students in nursing and medicine on patient safety.⁽¹⁶16 Yoshikawa JM, Sousa BEC, Peterlini MAS, Kusahara DM, Pedreira MLG, Avelar AFM. Comprehension of undergraduate students in nursing and medicine on patient safety. Acta Paul Enferm [Internet]. 2013 [cited 2016 Dec 15]; 26(1):21-9. Available from: http://www.scielo.br/pdf/ape/v26n1/en_05.pdf http://www.scielo.br/pdf/ape/v26n1/en_05... ⁾	Web of Science 2013	Descriptive study	To evaluate the perspectives of undergraduate nursing and medical students about the human error and patient safety.	Sixty-four percent of the students agreed that, faced with an error, people involved in the situation must discuss its occurrence and establish effective prevention strategies, such as working more carefully, mentioned by 78% of the participants. Eight-four percent of the students said that professionals should not agree to work in places that do not offer proper conditions. Although 87.2% of the students answered that they communicated with their professor about the presence of conditions in training centers that favored errors, 33.9% did not want to tell patients and families about it if it did not cause harm to patients. Most students (91.7%) believed that error notification systems contributed to reducing the occurrence of mistakes.
Patient safety attitudes and behaviors of graduating medical students⁽¹⁷17 Wetzel AP, Dow AW, Mazmanian PE. Patient safety attitudes and behaviors of graduating medical students. Eval Health Prof [Internet]. 2012 [cited 2017 Mar 19]; 35:221-38. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21788294 https://www.ncbi.nlm.nih.gov/pubmed/2178... ⁾	Web of Science 2011	Descriptive study	To describe the current behaviors and attitudes of medical students regarding patient safety and identify the areas that must be focused on in the design of curricula oriented to this subject.	Although most students had the desired attitudes about patient safety education, more space in the curriculum should be devoted to the causes of errors and effects of long working hours on safety. Students' skills, confidence about reporting errors, and disclosure were insufficient. Behavioral and teamwork aspects must be formally included in the curriculum.
Health professionals and hand hygiene: a question of pediatric patient safety ⁽¹⁸18 Botene DZAB, Pedro ENRB. Health Professionals and hand hygiene: a question of pediatric patient safety. Rev Gaúcha Enferm [Internet]. 2014 [cited 2017 Mar 19]; 35(3):124-9. Available from http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/44306/31526⁾	CINAHL 2014	Descriptive study	To analyze how academic training on hand hygiene contributes to pediatric patient safety.	There were gaps in the hand hygiene training process. Academic training had very little effect on creating a patient safety culture, and the subject was not taught in enough depth in the course.
Human error and patient safety: an interdisciplinary course⁽¹⁹19 Wilson AR, Fabri PJ, Wolfson J. Human error and patient safety: interdisciplinary course. Teach Learn Med [Internet]. 2012 [cited 2017 Mar 19]; 24(1):18-25. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22250931 https://www.ncbi.nlm.nih.gov/pubmed/2225... ⁾	CINAHL 2012	Descriptive study	To describe an interdisciplinary program oriented to approaches to human error and patient safety in the curriculum of nursing courses.	Nursing undergraduates obtained higher scores in each evaluated category (errors and patient safety). All the students classified the program as satisfactory, pointing to an increased ability to work in interprofessional environments. They also presented improved knowledge and skills regarding patient safety and human error.
Curricular evaluation
A patient safety curriculum for graduate medical education: results from a needs assessment by educators and patient safety experts⁽²⁰20 Varkey P, Karlapudi S, Rose S, Swensen S. A patient safety curriculum for graduate medical education: Results from a needs assessment of educators and patient safety experts. Am J Med Qual [Internet]. 2009 [cited 2017 Mar 19]; 24:214-1. Available from: http://journals.sagepub.com/doi/pdf/10.1177/1062860609332905 http://journals.sagepub.com/doi/pdf/10.1... ⁾	Web of Science 2009	Descriptive study	To evaluate the needs in the development of a patient safety curriculum in medical courses.	The interviewees suggested 21 patient safety topics that they considered necessary to their curriculum, related to cultural, cognitive and technical content. The items included communication and shift changes, sentinel reports, event management, hand hygiene, universal protocols, fatigue, and safety culture. Structured clinical exams and experience-based learning, including simulations, stood out among the most effective methods to teach and evaluate patient safety.
Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education⁽²¹21 Allen S, Caton C, Cluver J, Mainous AG, Clyburn B. Targeting improvements in patient safety at a large academic center: an institutional handoff curriculum for graduate medical education. Acad Med [Internet]. 2014 [cited 2017 Mar 19]; 89(10):1366-9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25119553 https://www.ncbi.nlm.nih.gov/pubmed/2511... ⁾	Web of Science 2014	Descriptive study	To evaluate the development and implementation of a handoff shift change curriculum for medical students.	The designed curriculum included sessions of simulated experience of shift changes, with small and large groups. After the training, medical students were capable of recognizing the time dedicated to oral communication during shift changes and information recorded as important for effective communication and interaction with patients.
Web-based reporting of hazards and near-misses as part of a patient safety curriculum⁽²²22 Currie LM, Desjardins KS, Levine ES. Web-based hazard and near-miss reporting as part of a patient safety curriculum. J Nurs Educ [Internet]. 2009 [cited 2017 Mar 19]; 48(12):669-77. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20000248 https://www.ncbi.nlm.nih.gov/pubmed/2000... ⁾	Europe PMC 2009	Descriptive study	To test a communication system that included didactic content focused on error identification and the innovative use of information technologies, contributing to the implementation of a curriculum oriented to patient safety.	The communication system identified that, among the most common error reports, the following stood out: infections, medications, environment, falls and equipment. It is necessary to design a better curricular approach for the integration of patient safety concepts and the need to report adverse events.
Teaching patient safety in the medical undergraduate program at the Federal University ofSãoPaulo⁽²³23 Bohomol E, Cunha ICKO. Teaching patient safety in the medical undergraduate program at the Universidade Federal de São Paulo. Einstein [Internet]. 2015 [cited 2017 Mar 17]; 13(1):7-13. Available from: http://www.scielo.br/pdf/eins/v13n1/1679-4508-eins-13-1-007.pdf http://www.scielo.br/pdf/eins/v13n1/1679... ⁾	PubMed 2015	Descriptive-documentary study	To analyze the pedagogical projects of a medical course to verify that the content taught related to patient safety and inspired reflections about educational practice.	The teaching of patient safety was fragmented and focused on clinical skills, such as disease diagnosis and treatment, post-treatment, surgical procedures and follow-up. It confronts educational proposals based on traditional structures, centered on subjects and specific training, and is little valued.

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[1] CORRESPONDING AUTHOR: Denise de Andrade E-mail: dandrade@eerp.usp.br