title: Impact of a multifaceted educational intervention including serious games to improve the management of invasive candidiasis in critically ill patients.
abstract: OBJECTIVE
  Infections caused by Candida species are common in critically ill patients and contribute to significant morbidity and mortality. The EPICO Project (Epico 1 and Epico 2.0 studies) recently used a Delphi approach to elaborate guidelines for the diagnosis and treatment of this condition in critically ill adult patients. We aimed to evaluate the impact of a multifaceted educational intervention based on the Epico 1 and Epico 2.0 recommendations.
  
  
  METHODS
  Specialists anonymously responded to two online surveys before and after a multifaceted educational intervention consisting of 60-min educational sessions, the distribution of slide kits and pocket guides with the recommendations, and an interactive virtual case presented at a teleconference and available for online consultation.
  
  
  METHODS
  A total of 74 Spanish hospitals.
  
  
  METHODS
  Specialists of the Intensive Care Units in the participating hospitals.
  
  
  METHODS
  Specialist knowledge and reported practices evaluated using a survey. The McNemar test was used to compare the responses in the pre- and post-intervention surveys.
  
  
  RESULTS
  A total of 255 and 248 specialists completed both surveys, in both periods, respectively. The pre-intervention surveys showed many specialists to be unaware of the best approach for managing invasive candidiasis. After both educational interventions, specialist knowledge and reported practices were found to be more in line with nearly all the recommendations of the Epico 1 and Epico 2.0 guidelines, except as regards de-escalation from echinocandins to fluconazole in Candida glabrata infections (p=0.055), and the duration of antifungal treatment in both candidemia and peritoneal candidiasis.
  
  
  CONCLUSIONS
  This multifaceted educational intervention based on the Epico Project recommendations improved specialist knowledge of the management of invasive candidiasis in critically ill patients.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Shock, Organ Dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain. Electronic address: r.ferrer@vhebron.net.
authors.forename: R
authors.initials: R
authors.lastname: Ferrer
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Zaragoza
authors.affiliation: Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Llinares
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Maseda
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario Juan XXIII, Tarragona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Facultad de Medicina y Odontología de la Universidad del País Vasco, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Quindós
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D015415:Biomarkers; D058365:Candidiasis, Invasive / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods*; D019468:Disease Management; D004502:Education, Medical, Continuing / Q000379:methods*; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D008511:Medicine; D009503:Neutropenia / Q000150:complications; D010538:Peritonitis / Q000188:drug therapy / Q000382:microbiology; D010820:Physicians / Q000523:psychology; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D051437:Renal Insufficiency / Q000150:complications; D013030:Spain; D018910:Video Games
chemical_list: D000935:Antifungal Agents; D015415:Biomarkers
keywords: Candidiasis invasiva; Critically ill patients; EPICO project; Interactive games; Intervención educativa múltiple; Invasive candidiasis; Juegos interactivos; Mejora de la calidad; Multifaceted educational intervention; Paciente crítico; Proyecto EPICO; Quality improvement; Recomendaciones; Recommendations