# Enhancing Healthcare Associated Infections (HAI) Education in Asia with Simulation pedagogy

> In this blog, we share the highlights, challenges, and insights gained during our efforts to support the Asian colleagues in their development journey, particularly with simulation pedagogy.

## Project Background
Healthcare Associated Infections (HAI) pose a significant risk to patient safety worldwide, particularly in developing countries like Vietnam and Cambodia, where they contribute to increased morbidity and mortality. To address this issue, the Erasmus+ funded PrevInf-project was initiated in 2021. Led by the Portuguese Nursing School of Coimbra and Savonia University of Applied Sciences, the project aims to improve HAI prevention and control competence among Asian nurses and nursing students.

The project partners include:
*   **Vietnam:** Nam Dinh University of Nursing and Hai Duong Medical Technical University
*   **Cambodia:** International University and Bolyno Institute

## Implementation of Simulation Pedagogy
The project strives to empower Asian universities to incorporate scenario-based simulation pedagogy into their HAI curriculum. Despite having only minor prior experience with simulation, these universities have embarked on a significant pedagogical shift with the support of the Savonia team.

Each Asian partner successfully designed and implemented three HAI simulation scenarios, totaling 12 scenarios across the project. The guidance process included:
*   Online presentations on simulation pedagogy.
*   Instructional videos and written guidelines.
*   Numerous online meetings for scenario development.
*   Transnational meetings featuring hands-on simulation practice sessions.
*   Piloting the scenarios with students to gather feedback.

## Challenges and Strategies
The project faced several hurdles, which were addressed through patience and open communication:
*   **Geographical and Time Differences:** A 6 to 7-hour time difference necessitated a reliance on online collaboration.
*   **COVID-19 Pandemic:** Prevented face-to-face meetings for an extended period, reinforcing the need for virtual communication.
*   **Complexity of Pedagogy:** To convey complex information, the team produced video materials, supplied learning resources, and recorded all guidance sessions for later review.
*   **Language and Culture:** Variations in English proficiency and differing nursing practices across continents added layers of complexity that were managed through a shared commitment to the project.

## Insights and Future Outlook
The project revealed that simulation pedagogy is highly suitable for both Finnish and Asian students, as fundamental infection prevention practices and potential errors are universal. Key insights include:
*   Successful implementation requires investment in resources (facilities and manikins) and comprehensive faculty training.
*   Educators must shift away from traditional pedagogical approaches toward a new mindset.
*   Cultural aspects must be recognized and considered for successful integration.
*   Simulation provides a safe environment for students to practice clinical skills, critical thinking, and decision-making.

The Savonia team expresses confidence that the Asian partners will sustain these practices and become role models for simulation pedagogy in their region.

## References
*   Phu VD, et al. (2016). Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units. *PLoS One* 11(1). doi: https://doi.org/10.1371/journal.pone.0147544
*   Kim E, Kim SS & Kim S. (2020). Effects of Infection Control Education for Nursing Students Using Standardized Patients vs. Peer Role-Play. *Int. J. Environ. Res. Public Health* 18(1). doi: https://doi.org/10.3390/ijerph18010107
*   Ling ML, Apisarnthanarak A, Madriaga G. (2015). The burden of healthcare-associated infections in Southeast Asia: A Systematic Literature Review and Meta-analysis. *Clinical Infectious Diseases* 60(11), 1690–1699. doi: https://doi.org/10.1093/cid/civ095
*   Silén-Lipponen M, Koponen L, Korhonen U & Myllymäki M. (2022). Using a Massive Open Online Course (MOOC) to promote infection prevention and control learning in healthcare education. *International Journal of Infection Control*, 18. https://doi.org/10.3396/ijic.v18.21667

## Authors
*   **Mikko Myllymäki**, Senior Lecturer, MSc, RN, Savonia University of Applied Sciences, Department of Health care, mikko.myllymaki@savonia.fi
*   **Marja Silén-Lipponen**, Principal Lecturer, PhD, Savonia University of Applied Sciences, Department of Health care, marja.silen-lipponen@savonia.fi
*   **Leena Koponen**, Senior Lecturer, MSc, RN, Savonia University of Applied Sciences, Department of Health care, leena.koponen@savonia.fi
*   **Ulla Korhonen**, Senior Lecturer, MSc, BLS, Savonia University of Applied Sciences, Department of Health care, ulla.korhonen@savonia.fi