Can Virtual Competencies Replace Hands-On Training? APIC 2026 Study Links In-Person Education to Major CAUTI Reduction

A quality improvement initiative at Hackensack Meridian Health's Ocean University Medical Center suggests that health care organizations may need to reconsider the growing reliance on virtual competency assessments for high-risk clinical procedures.

At the Association for Professionals in Infection Prevention and Epidemiology Annual Conference and Exposition held from June 15 to 17, 2026, in Nashville, Tennessee, a poster presentation covering this topic is titled "Are We Losing Essential Skills? A Case for Re-evaluating In-Person Training over Virtual Competencies," presented by Jill Armstrong, BSN, RN, CIC, Infection Preventionist, Jayme Bland, MSN, CCRN, CIC; Nancy Kerr, MSN, CIC, RN, FSHEA, Karen Pasco MS, MBA, MT, CIC, at Hackensack Meridian Health–Ocean University Medical Center. On the poster, the authors demonstrated that reinstating hands-on urinary catheter competency training was associated with a substantial reduction in catheter-associated urinary tract infections (CAUTIs).

"CAUTIs are one of the most common healthcare-associated infections and remain a significant threat to patient safety and quality," Armstrong and colleagues wrote. The team launched the project after observing an increase in CAUTI rates following a 2020 transition from inperson urinary catheter training to virtual competency assessments.

The organization sought to determine whether returning to practical, hands-on education could improve clinical performance and ultimately reduce infections.

The initiative involved multiple interventions implemented over several quarters. Following a needs assessment in the third quarter of 2023 and a product in-service during the fourth quarter, the medical center deployed a mandatory standardized prevention training module to all registered nurses during the first quarter of 2024.

The cornerstone of the project occurred between the second and fourth quarters of 2024, when nurses completed hands-on competency validation for urinary catheter insertion, maintenance, and specimen collection procedures. According to the poster, the program achieved a 91% staff completion rate.

Additional efforts included ongoing surveillance of catheter appropriateness and continued adherence to a nurse-driven urinary catheter removal protocol.

The results were striking.

Researchers reported a 46% reduction in CAUTIs in 2024 following the implementation of educational and competency-based interventions. The team also documented significant improvements in key infection prevention metrics.

There was an 80% decrease in the facility's standardized infection ratio (SIR) since the fourth quarter of 2022 and a 20% decrease in the standardized utilization ratio (SUR) since the first quarter of 2023.

"The implementation of this comprehensive program resulted in a 46% reduction in catheter-associated urinary tract infections in 2024," Armstrong and colleagues reported. "This improvement directly followed the mandatory education and updated bladder management protocols, with hands-on competency testing being a key element."

The findings raise important questions for health care organizations that increasingly rely on virtual education and electronic competency assessments to train staff.

While virtual learning offers convenience and scalability, the results suggest that certain technical skills may benefit from direct observation and practical validation. The authors noted that a "strong correlation was observed between enhanced, practical education and improved patient outcomes."

The team concluded that hands-on competency verification should remain a critical component of infection prevention education, particularly for procedures associated with healthcare-associated infection risk.

"The significant reduction in [CAUTI] rates, along with decreases in both the [SIR] and [SUR], highlights the effectiveness of reinstating in-person, hands-on training within a multifaceted quality improvement project," Armstrong and colleagues wrote.

As health care facilities continue to balance operational efficiency with clinical excellence, the findings suggest that, in some cases, a return to hands-on education may offer measurable benefits for staff competency and patient safety.

The authors concluded that comprehensive educational programs that include practical skills validation can play an important role in reducing healthcare-associated infections and improving patient outcomes.