Carnage and Contagion: Can Zombie Pop Culture be used to improve infection prevention and control practices

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“The Walking Dead. Scientific name Homo Coprophagus somnambulus. A deceased human being who has partially returned to life due to undeterminable causes.”
The Urban Dictionary, 2014.

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Popular culture and urban mythology is not an unknown method of educating and training individuals in a number of fields. Whether it is supernatural or science fiction themed, the use of pop-culture references can enhance the learning experience for individuals and groups as a whole, writes Dr Peta-Anne Zimmerman and Matt Mason.
Popular culture has, throughout history, initiated innovation that has led to science fiction becoming science fact. It was not so long ago that Aldous Huxley was describing A Brave New World, Isaac Asimov was writing the first law of robotics and Gene Rodenberry and the Star Trek team were introducing us to what we now call teleconferencing, mobile phones and tablets. Are we not far off having ‘tri-corders’ as a diagnostic instrument for medicine with our use of hand held thermal scanners?
Pop-culture as a pedagogical device uses what people know and have experienced, even through media and story-telling via film and TV, to learn. It uses what Rogers, Kuiper and Kirker (1977) described as the “self-referential effect” where an individual can relate to an idea or concept because they have lived it either physically or in their mind by processing a story. Because of this identification, they remember and can contextualise it. All of this is, dependent upon the target audience and the pop-cultural references that they will respond to. But it remains that using such devices encourages active learning, corrects misconceptions, instils greater self-confidence and provides a better understanding of concepts.
So, why are we suggesting that the pop-culture reference of zombies is a good teaching device to improve infection prevention and control practice?
It all started with a twitter conversation, being the pop-culture geeks that we are, when a question was asked as to “What is your favourite movie with an infectious disease cause?” One of us responded with Shaun of the Dead, which created an avalanche of zombie film suggestions. Someone then suggested that these didn’t count but we and others argued differently citing the many films that did indeed have a pathogenic cause for “zombification”. Buoyed by the idea that a number of us working in infection control were also pop-culture geeks we thought some research was in order.
Wikipedia currently lists 383 feature length “A-list” zombie films, released between 1932 and 2014. These films indicated a number of causes of “zombification” including microbial agents which have not been contained and spread readily from person to person. We further searched English language feature length films, released from 2000-2014. Each film was checked against the public online databases iMDB, Rotten Tomatoes and Wikipedia to identify the cause of the zombie infestation featured in each film.
On review of the films included on the Wikipedia list, 238 zombie films were released from 2000 to date (Wikipedia, 2014). Of these, 69 films had an infectious cause of some kind (viral, bacterial, parasite, extra-terrestrial, zoonotic or other biological cause). For 48 films, the cause was unclear. In the remainder (n=121), zombification had no traceable infectious cause. When looking at release dates we realised there was a possible link between zombification cause and global health events.
To test our hypothesis, we mapped the year of release of pathogenic zombie films against the World Health Organization’s list of infectious disease outbreaks as seen in Figure 1 (World Health Organization [WHO], 2014). This demonstrated a correlation between the two, with an increase in the release of infectious bio horror films in the years following outbreaks such as SARS and pandemic influenza. So it appeared that global health threats have an impact on pop-culture media. This is also reported in the literature where horror films are identified as a barometer of society’s fears, anxieties and cultural consciousness (Bishop, 2009).
Figure 1
To provide more insight into this, British zombie film maker, Anthony D Lane, currently producing and directing Invasion of the Not Quite Dead stated: “It (global outbreaks) definitely has an impact on our films. Our latest film is about an infectious disease that escapes from a lab and causes an outbreak in the town” (2014).
The zombie phenomenon has also been used by the United States Centers for Disease Control and Prevention (CDC) as a promotional device for public health preparedness and response (2014). The United States Strategic Command has used zombies to train junior officers citing: “Using this fictitious scenario avoided concerns over the use of classified information, it resolved sensitivity to using real-world nations or scenarios, and it better engaged the students” (United States Strategic Command, 2014). The literature also demonstrates its use in mathematical modelling for disease outbreaks and for use in raising public health awareness, prevention and containment strategies (Verran, Crossley, Carolan, Jacobs, & Amos, 2014; Nasiruddin, Halabi, Dao, Chen, & Brown, 2013; Munz, Hudea, Imad, & Smith, 2009).
So, how do we best make use of these relationships to teach healthcare workers about safe infection prevention and control practice?
Firstly, it is important to pick your audience and match the images to their sensibilities. While the Traffic Accident Commission of Victoria has proven since the late 1980s there is a role in confronting an audience, zombies aren’t for everyone and we need to be mindful that we don’t turn people away from the message through the images we choose to use (Traffic Accident Commission, 2015). When choosing clips or images you may find that groups of extroverts such as nurses from the Emergency Department are more likely to engage with zombie references than others. This is a generalisation however and you will need to ascertain the level of acceptance within your intended audience. Providing a warning about graphic content before you start your session is advisable.
Once the audience is identified you then need to choose images/clips that illustrate the points you are trying to highlight. Zombie films, World War Z being an exception, tend not to be box office smashes so they are also unlikely to be well known outside of those with an interest in the genre. Because of this you cannot count on subtext within the film to be known and need to choose images/clips that are unambiguous and clearly linked to your message.
Another issue to consider is that many of these films will be low budget and possibly low in quality which may reflect on your presentation. Films such as Shaun of the Dead and 28 Days Later offer high quality production values and a range of scenes that can be used to support infection prevention and control practice (Universal Pictures, 2004; DNA Films, 2002). Examples that we have used include using a scene from Shaun of Dead to highlight the use of personal protective equipment (PPE) in trauma settings (Figure 2) and a scene from the Australian movie Undead championing the role of the infection prevention and control professional (Figure 3) (Universal Pictures, 2004; Spierigfilm, 2003).
Capturing the images/clips is not particularly difficult. Many of the more popular scenes/films are available on YouTube which has a facility to embed your choice within a PowerPoint presentation for example. This now includes an option to embed a trimmed clip so that you are only including the parts of the movie you want to show! If you are feeling a little more adventurous it is possible, and a lot of fun, to make your own clip. This is particularly engaging if you get staff involved and adds to the reinforcement of the message. Making a short clip can be done cheaply through the use of a smartphone or digital camera and editing software such as Windows Movie Maker. Again YouTube is a great resource here with many videos being available to help you through the technical aspects of doing this.
Figure 2
This picture (above) can be used to highlight PPE use. In this scene Shaun and Ed have just dispatched two Zombies and have blood splatter on their clothes as can occur in a trauma presentation (Universal Pictures, 2004).
Figure 3
Rene is the heroine in this movie (as pictured above) that ends with her overseeing the containment of the town’s zombie population, much like an infection prevention and control professional does in an outbreak of disease (but without the gun) (Spierigfilm, 2003).
The ease in which pop-culture references can be incorporated into educational and/or awareness campaigns is evident, as is the success factor for participants remembering what they have actually learned. When it comes to our specialty, zombies are a natural conduit to educate about emerging infectious diseases and the importance of infection prevention and control practices. Reoccurring themes in films that can be adapted to provide case studies include unknown transmission routes; appropriate use of PPE; quarantine and isolation and identifying and managing personal exposure. And it isn’t just limited to traditional methods of educational delivery. Think smartphones, apps, gaming, online learning packages and team building exercises.
The sky really is the limit, but just be careful, that sky could contain highly pathogenic extra-terrestrial zombie causing disease. So…be prepared.

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Bibliography

• 28 Days Later. (2002). Motion picture, DNA Films, London.


• Bishop, K. (2009). Dead man still walking: Explaining the zombie renaissance, Journal of Popular Film and Television, 37, 16-25.


• Centers for Disease Control and Prevention (CDC). (2014). “Zombie Preparedness”, http://www.cdc. gov/phpr/zombies.htm
  


• Gagnon, J. W. Jr., & Collay, M. (2006). Constructivist learning design: Key questions for teaching to standards. Thousand Oaks, CA: Corwin.


• Lane, A. (2014). Personal Communication. Producer/Director “Invasion of the Not Quite Dead”, London, UK.


• Lowe, L., & Hummel, F. (2014). Disaster Readiness for Nurses in the Workplace, Workplace Health and Safety, 62,207-213.


• Ludwig, K. (2012). Using Pop Culture to Teach Biomechanics, Journal Of Physical Education Recreation and Dance, 83, 27-30.


• Munz, P., Hudea, I., Imad, J., & Smith, T.J. “When zombies attack!: Mathematical modelling of an outbreak of zombie infection” p.133-150 in Infectious disease modelling research progress. Tchuenche, J. M., & Chiyaka, C. Ed (2009). New York: Nova Science Publishers.


• Nasiruddin, M., Halabi, M., Dao, A., Chen, K., & Brown, B. (2013). Zombies--a pop culture resource for public health awareness. Emerging Infectious Diseases, 19(5), 809-813. doi:10.3201/eid1905.AD1905


• Rogers, T. B., Kuiper, N.A., & Kirker, W. S. (1977). Self-reference and the encoding of personal information. Journal of Personality and Social Psychology, 35, 677-688.


• Shaun of the Dead. (2004). Motion picture, Universal Pictures, London.


• Traffic Accident Commission. (2015). TAC 20 year anniversary retrospective montage “Everybody Hurts” https://www.tac.vic.gov.au/road-safety/tac-campaigns/20- year-campaign
  


• Undead. (2003). Motion picture, Spierigfilm, Qld, Australia.


• United States Strategic Command (USSCOMM). (2014). CDR SSTRATCOM CO~PLAN 8888-ll “COUNTER-ZOMBIE DOMINANCE” 30 APR ‘2011 http://www.stratcom.mil/files/foia_requests/CONPLAN%208888-11.pdf
  


• Verran, J., Crossley, M., Carolan, K., Jacobs, N., & Amos, M. (2014). Monsters, microbiology and mathematics: The epidemiology of a zombie apocalypse. Journal of Biological Education, 48(2), 98-104.


• Wikipedia. (2014). “List of Zombie Films”, http://en.wikipedia.org/wiki/List_of_zombie_films
  

Dr Peta-Anne Zimmerman RN BN MHSc(Infection Control) DPH CICP
Mr Matt Mason RN CICP BNSci M Rural Health M Advanced Practice (IC)
Peta-Anne and Matt are both experienced, credentialed Infection Prevention and Control Professionals in both acute and public health settings. Both have been trained and deployed overseas by the Global Outbreak Alert and Response Network.
Peta-Anne is a lecturer at the School of Nursing and Midwifery, Griffith University and is convenor for the Graduate Infection Prevention and Control Program and Matthew is a lecturer at the School of Nursing an Midwifery, the University of the Sunshine Coast. Both have conducted research and have published and presented dometically and internationally in the field of Infection Prevention and Control. They both hold current positions on the Australasian College for Infection Prevention and Control (ACIPC) Credentialling and Professional Standards Committee.
Peta-Anne and Matt happily identify as pop-culture geeks.
Twitter:
Peta-Anne @IPCPau Matt @MattM_RN #carnageandcontagion #cricketbatsandcontainment