Patient Care, Training

Evidence-Based Teaching Applied to Infection Control

Issue 11 and Volume 35.

Malcolm Knowles, recognized as one of the leading authorities in the field of adult education, states that establishing an environment for learning begins with “setting a climate for mutual inquiry.” Mutual inquiry—for the instructor and the learner—is important for class participants to become self-directed learners.

Becoming a self-directed learner is a primary goal. Self-directed learning occurs when the student accepts the primary responsibility for planning, implementing and evaluating the learning process, using the instructor as a resource.1

Opinions as to the most effective way for individuals to learn also vary. In fire and EMS, the training position is often a short-term assignment made without preparation. This can lead to individuals performing the job based on impressions, past trends and old habits; thus, education isn’t advanced. This may be especially true in the area of infectious and communicable disease education and training. An approach that may assist both the instructor and the student is evidence-based learning.

The Theory
Evidence-based medicine, continues to be an important topic in education. Evidence-based learning uses science and research in training. This approach removes hype, fear and unsupported information from the learning process, which is particularly important in education on infectious and communicable disease.

Proponents of evidence-based education suggest that practitioners and policy makers base decisions on scientific research findings, using medicine as an example of how scientific research can lead to improvements in practice. Medical research uses random experiments as the tool to decide which clinical practices are most effective. Advocates for evidence-based education believe this approach will lead to dramatic improvements in education, as it has in medicine.

Over the years, a cooperative relationship between researchers and practitioners has affected many fields. For example, health researchers developed a theory that “germs” are the cause of infection and disease, and then medical practitioners put that knowledge into practice. Practitioners identified ways that germs might be transmitted, such as through unwashed hands, and thought of ways to limit that transmission—hand washing and/or glove use. Researchers then tested these approaches. Once both researchers and practitioners accepted the germ theory, they were able to work together to dramatically lower disease and infection rates.2

Infection Control
Education and training on blood-borne and airborne/droplet diseases came to the forefront in December 1991 with the publication of the Occupational Safety & Health Administration (OSHA) blood-borne pathogens regulation. This regulation required education and training on such diseases as hepatitis B and C, human immunodeficiency virus (HIV) and syphilis. However, many educators missed OSHA’s compliance directive for the blood-borne pathogens regulation (CPL 2-2.69), which further described the training requirements and the need for trainers to be “qualified.”

The education and training requirement didn’t focus on understanding the contents of the OSHA regulation but rather understanding each of the diseases. Understanding risk, mode of transmission, the disease transmission process and post-exposure medical management leads to development of a comfort level in the health-care workplace environment. If proper scientific evidence isn’t given, and the focus is only on personal protective equipment, then fear may be the result.

As stated in Abraham Maslow’s hierarchy of needs, “fear can keep us immobilized and unable to make the change.” Instructors should use scientific evidence, instead of fear and emotion, during communicable disease training to encourage a greater comfort level for providers. For example, if good scientific information is given regarding the need for the seasonal influenza vaccine, provider participation in vaccine programs may increase.

The Practice
Sometimes instructors need to learn because not everyone is a subject-matter expert. Assess your understanding of the information. Answer your questions before conducting a training program. This can be achieved by reading OSHA compliance directive CPL 2-2.69, which explains training requirements. Be a proactive, self-directed learner by conducting a literature search of reliable Web sites.

Maintain Your Credibility
Review existing training materials and ensure they’re correct and updated. Don’t rely on the work of others without conducting a literature review for the most current information. You may find that a lot of information that contradicts what has been previously presented. Evidence-based research will assist you in evaluating any new studies you find. Remember, you can always find a new study, but you need at least three studies conducted the same way for credibility and scientific validity. New information will be challenged, so be prepared and do your homework. If you present incorrect information and lose your credibility, you won’t be able to get it back.

What You Need
Conducting a needs assessment is a basic part of instructor preparation, but it isn’t often undertaken. An educational-needs assessment can be performed in several ways:
1. A review of exposure data;
2. A review of department compliance monitors; and
3. A survey of the members of the department.

Exposure data and the findings of compliance monitoring can be obtained from your department’s designated infection control officer (DICO) or safety officer. This data is required in annual training updates under the OSHA blood-borne pathogen regulation.

Be Flexible
When introducing new information, whether it’s in new-hire training or annual update training, it’s important to be flexible. There may be a need to deviate from the lesson plan to address key concerns that arise in the classroom. For example, if an outbreak of pertussis (whooping cough) is reported in your area, it should be covered in training because it’s key to the work practice. Here, you need to deviate from blood-borne pathogens and tuberculosis to focus on pertussis and whether department members have received their tetanus, diphtheria and acellular pertussis (Tdap) boosters for protection. Being flexible and meeting your student’s needs are two critical goals for a good instructor.

Encourage Participation
Class discussion gives an opportunity to participate in the process and bring out ideas and experiences. Encouraging participation will assist you in assessing the learning that’s taking place. In reviewing the questions that were asked during the session, the trainer can decide if additional clarification and supportive data is needed. Distributing supportive handouts prior to the class will aid discussion.3

Training on blood-borne pathogens and airborne/droplet is an area that’s constantly changing and evolving. It’s important to provide your students with accurate and current information that’s confirmed by science and work to dispel fear and emotion. It’s also essential that you show interest in the subject matter. Stimulate the learning process by presenting information in a manner that motivates individuals to learn and to question. JEMS


  • Knowles, M: Self-directed Learning: A guide for learners and teachers. Follett Publishing Company: Chicago. 1975.
  • Manzoukas, S. A review of evidence-based practice, nursing research and reflection: Leveling the hierarchy. J Clin Nurs. 2008;17:214–223.
  • LeBlanc R. Good Teaching: The Top Ten Requirements.

This article originally appeared in November 2010 JEMS as “Infection Instruction: Take the fear out of the classroom.”