Educational Escape Rooms for Infection Prevention and Patient Safety Training in Medical and Nursing Education: A Systematic Review and Meta-Analysis

Educational escape rooms have emerged as innovative tools for infection prevention and patient safety training, yet their overall effectiveness remains unclear. The existing literature shows substantial variation in instructional design, learner populations, and measured outcomes, highlighting the need for a systematic evaluation of their impact on knowledge, behavioral readiness, and process performance. To address this, we conducted a systematic review and meta-analysis in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched without date restrictions, and studies were included if they employed escape room-based training for infection prevention or patient safety and reported quantitative outcomes. Risk of bias was assessed using design-specific tools, and meta-analyses were performed for outcomes reported by at least two independent studies. Twelve studies met the inclusion criteria. Meta-analysis of immediate post-training knowledge revealed a statistically significant improvement associated with escape room participation (pooled standardized mean differences (SMD) ≈ 0.86; 95% confidence interval (CI) ≈ 0.33-1.39), despite substantial heterogeneity (I² > 80%). Knowledge retention over 1-3 months showed a positive but less precise effect (pooled SMD ≈ 0.72; 95% CI ≈ −0.02-1.45). Qualitative synthesis indicated consistent benefits in engagement, self-efficacy, perceived preparedness, and teamwork, alongside favorable trends in process measures such as procedural adherence and safety behaviors; however, most of these outcomes were derived from uncontrolled studies. Overall, escape room-based interventions appear to enhance immediate knowledge in infection prevention and patient safety, with promising yet uncertain effects on knowledge retention, behavioral readiness, and process outcomes. While the findings support their educational value, methodological limitations in the existing evidence warrant cautious interpretation and further rigorous investigation.