Efficacy of the Web-Based Gamified Infection Control Training System on Practices for Health Care Workers in Residential Care Homes: Clustered Randomized Controlled Trial

Background: Staff working in residential care homes (RCHs) have played a significant role in preventing the spread of infection among residents, visitors, and staff. Providing continuous professional training to the staff is essential. Current infection control training mostly rests on short educational talks or one-to-one reminders in the RCHs. A blended mode of online interactive games and face-to-face consultations was now proposed as a new way to conduct infection control training in the RCHs. Objective: This study aims to assess the efficacy of the Blended Gaming COVID-19 Training System (BGCTS) on infection control practices and self-reported knowledge, attitude, and practices of standard precautions among health care workers in RCHs. Methods: A 2-arm, single-blinded, parallel cluster randomized controlled trial was designed, and 30 RCHs were recruited and randomized into an intervention group to receive the BGCTS and a control group to receive usual care on infection control training. Due to the COVID-19 pandemic and infected cases in the homes, 17 RCHs refused or delayed the on-site observations. The BGCTS intervention, developed based on “The COVID-19 Risk Communication Package for Healthcare Facilities” of the World Health Organization, consists of two parts: (1) an eHealth mode of a 120-minute web-based training system covering 8 topics, delivered in short-clip videos and games, and (2) two 30-minute face-to-face interactive sessions for concept clarification. The 2 infection control practices, “use of gloves and personal protective equipment (PPE) and performing respiratory hygiene” and “hand rub,” were assessed by on-site unobtrusive observations, and self-reported infection control practices and knowledge and attitude toward infection control were measured via online survey post intervention. Results: A total of 212 staff from 13 RCHs were involved in the analysis, with 7 RCHs from the intervention group (n=114) and 6 RCHs from the control group (n=98). A significantly greater increase in the proportions of proper use of gloves and PPE and respiratory hygiene performance (β=.195, 95% CI 0.046-0.344; P=.02) and properly performed hand rub (β=.068, 95% CI 0.005-0.132; P=.04) was observed in the intervention group. The changes in the self-reported outcomes were not statistically significant. Conclusions: BGCTS improved RCH staff’s performance in 2 infection control practices by objective measurement, “gloves and PPE use and performance in respiratory hygiene” and “hand rub.” BGCTS was shown to be an effective training, although it was a 2-week intervention. The BGCTS did not perform better than infection control briefing sessions in self-reported infection control knowledge, attitude, and practices. This electronic-based infection control training with 2 intensive interactive sessions has good potential to be adopted as regular training in RCHs.