Pioneering infection prevention and control education through simulation-based learning: impact on knowledge and skills in nursing students in Tunisia

Infection prevention and control (IPC) is essential in healthcare settings, yet evidence on simulation-based learning (SBL) for nursing education in low- and middle-income countries remains limited. This study reports the first experience in Tunisia of integrating a procedural simulation unit focused on Ventilator-Associated Pneumonia (VAP) prevention into the nursing curriculum. A quasi-experimental pre–post study was conducted at the Higher Institute of Nursing Sciences of Tunis (ISSIT). Final-year nursing students (N = 109) participated in three procedural simulation workshops based on Kolb’s Experiential Learning Theory. Students’ knowledge and procedural skills were assessed using structured pre- and post-tests based on international guidelines. Additionally, the quality of the instructional process was evaluated using the Debriefing Assessment for Simulation in Healthcare – Student Version (DASH-SV). Data were analyzed using McNemar’s test for paired samples and Cohen’s d for effect size. At baseline, nursing students demonstrated substantial gaps in knowledge regarding VAP prevention and IPC principles; notably, incorrect response rates exceeded 50% for most items. Following the simulation workshops, significant improvements were observed across all assessed domains (p < 0.001). Overall scores increased substantially, with all students achieving a post-test score of at least 10/20, and 66.7% scoring ≥ 15/20. The DASH-SV revealed a high quality of debriefing (Mean global score: 6.85 ± 0.14/7), with a “ceiling effect” observed for instructor effectiveness and psychological safety. Simulation-based learning effectively improved nursing students’ IPC knowledge and procedural skills, demonstrating its feasibility for integration into nursing curricula in resource-limited settings. The high DASH scores confirm that a structured and psychologically safe learning environment was successfully established. This study provides a replicable model for future curriculum development to bridge the gap between theory and clinical practice in Tunisia. Not applicable.