Is virtual reality suitable for hand hygiene training in health care workers? Evaluating an application for acceptability and effectiveness

Visualizing the WHO "My Five Moments for Hand Hygiene," framework: A virtual reality training program for improving hand hygiene adherence among nurses

BACKGROUND

Health care-associated infections (HAIs) contribute to patient morbidity and mortality. Hand hygiene is essential for preventing HAIs, but training can fail to transfer to clinical practice. Experiential learning through virtual reality (VR) may improve adherence by offering realistic practice opportunities and feedback.

METHODS

We developed and evaluated a VR-based training program that uses the World Health Organization's (WHO) "My Five Moments for Hand Hygiene" framework to provide feedback about pathogen transmission and hand hygiene adherence in 4 clinical scenarios. Sixty-eight registered nurses from 4 hospitals in the United States completed the VR training program. Using the Theory of Planned Behavior, we assessed behavioral determinants (intention, attitudes, subjective norms, and perceived behavioral control [self-efficacy]) of hand hygiene adherence pre-, midway, and post training. We also measured overall adherence to the Five Moments in each scenario.

RESULTS

From the beginning to the end of the training program, self-efficacy scores and overall hand hygiene adherence in VR increased linearly by 11% (P=.02) and 68% (P<.001), respectively.

CONCLUSIONS

Our findings support VR as an educational tool for enhancing hand hygiene practices of health care workers. Future research should assess the transfer of training to clinical settings and its impact on real-world adherence and HAIs.

Effectiveness of sensing gloves-applied virtual reality education system on hand hygiene practice: A randomized controlled trial

BACKGROUND

We developed a virtual reality (VR) education system and evaluated its clinical utility for promoting hand hygiene practices.

METHODS

This prospective, 2-week, randomized controlled study conducted at Okayama University Hospital, Japan, from November 2023 to January 2024, involved 22 participants (18 medical students and 4 residents). A fully immersive 360° VR system (VIVE Pro Eye) using a head-mounted display and sensing gloves was used to develop 3 health care tasks in a virtual patient room-Environmental Cleaning, Gauze Exchange, and Urine Collection. After monitoring all participants' baseline usage data of portable hand-rubbing alcohol in the first week, we randomly assigned them into 1:1 groups (VR training and video lecture groups). The primary outcome was differences in hand-rubbed alcohol use before and after intervention.

RESULTS

Before the intervention, alcohol use did not significantly differ between both groups. After the intervention, a significant increase in alcohol use was observed in the VR training group (median: 8.2 g vs 16.2 g; P = .019) but not in the video lecture group.

CONCLUSIONS

Our immersive 360° VR education system enhanced hand hygiene practices. Infection prevention and control practitioners and digital technology experts must collaborate to advance the development of superior educational devices and content.

Immersive technology and hand hygiene: scoping review

BACKGROUND

The use of immersive technology in healthcare education is on the rise, yet its impact on learner engagement, knowledge retention, and specifically in areas like hand hygiene training, remains underexplored. The aim of this scoping review was to summarize the existing studies of immersive technology in hand hygiene training of healthcare providers and health professions students.

METHODS

A scoping review following the Levac et al. framework was conducted. The literature search was performed in databases PubMed, CINAHL Ultimate, ScienceDirect (Elsevier), Web of Science in addition to Google Scholar and ProQuest Dissertation & Theses. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews (PRIMSA-ScR) guideline was used to report the results. We analysed data using tabular and descriptive summary.

RESULTS

In the final analysis 11 studies from seven countries were included. Most of the studies (n = 10, 90,91%) used virtual reality in hand hygiene training of healthcare providers and health professions students. Most studies have found that immersive technology is useful in teaching hand hygiene (n = 6, 54,55%). There are some theories and concepts that support the teaching of hand hygiene with immersive technology, but most of the research is not supported by them. Theories or concepts were included in two studies (18,18%).

CONCLUSION

Immersive technology, especially virtual reality, enhances hand hygiene learning and engagement compared to traditional methods. However, most studies lack theoretical support. To advance this field, exploring immersive technology for further research and incorporating relevant theories is encouraged. Additionally, conducting a thorough cost-effectiveness analysis and establishing a robust evaluation framework, encompassing both short-term and long-term outcomes, will be beneficial for a comprehensive understanding of the impact of immersive technology in hand hygiene education.

Training of food handlers on handwashing using a virtual reality environment is more effective than traditional training approaches in a randomized trial

Handwashing is an essential prevention step in foodservice, This randomized comparative study assessed the effectiveness of three training methods -virtual reality (VR), Glo-Germ (GT), and traditional face-to-face training (CT)- in improving handwashing practices among foodservice workers (n = 129). Training focused on the World Health Organization's 11-step handwashing process. Handwashing in the workplace was observed, in a pre- and post-test design, with microbiological swabs also taken. There was an increase in time spent on handwashing that was noticeable across all three groups (p < 0.05) with the highest in the VR group (50.16 ± 26.04 sec.). The mean number of handwashing steps increased across all groups, and the highest increase (8.91 ± 1.49 steps) was observed in the VR group. A statistically significant difference was observed among all groups regarding correctly performed steps, and the VR group showed the highest number of steps (p < 0.01). These findings suggest that VR-based training has value for enhancing hand hygiene practices in foodservice settings.

Enhancing medical education for undergraduates: integrating virtual reality and case-based learning for shoulder joint

BACKGROUND

The integration of Virtual Reality (VR) with Case-Based Learning (CBL) has the potential to revolutionise undergraduate medical education, particularly in complex subjects such as the anatomy and rehabilitation of the shoulder joint. This study aimed to explore the effectiveness of this innovative approach in enhancing learning outcomes and knowledge retention.

METHODS

This study employed a parallel-group, assessor-blinded randomised controlled trial (RCT) design. A comprehensive five-week educational programme was developed, combining traditional lecture-based learning with VR-enhanced CBL. The study involved 82 undergraduate students from China Medical University, who were divided into groups receiving different combinations of VR and CBL. Student performance was evaluated through tests and questionnaires.

RESULTS

In the anatomy-related courses, the integration of VR technology with CBL yielded significantly higher results (87.71 ± 5.60) compared to traditional methods (82.59 ± 6.64), with a statistically significant difference (P < 0.05). This provides compelling evidence of VR's potential to enhance student engagement and knowledge retention. In the context of physiotherapy-related courses, however, while the test scores of the VR-combined CBL group (81.85 ± 5.99) were marginally higher than those of the traditional CBL group (79.02 ± 7.57), this difference was not statistically significant (P > 0.05).

CONCLUSION

The present study provides preliminary evidence for the benefits of incorporating VR into medical education, particularly in anatomy. While the results are promising, further research is needed to explore the optimal integration of VR and CBL in rehabilitation studies and to assess their long-term impact on student learning and clinical performance.

TRIAL REGISTRATION

The study was registered with Chinese Clinical Trials Registry (Registration Number: ChiCTR2400089295) on 05/09/2024.

Virtual reality and augmented reality smartphone applications for upskilling care home workers in hand hygiene: a realist multi-site feasibility, usability, acceptability, and efficacy study

OBJECTIVES

To assess the feasibility and implementation, usability, acceptability and efficacy of virtual reality (VR), and augmented reality (AR) smartphone applications for upskilling care home workers in hand hygiene and to explore underlying learning mechanisms.

MATERIALS AND METHODS

Care homes in Northwest England were recruited. We took a mixed-methods and pre-test and post-test approach by analyzing uptake and completion rates of AR, immersive VR or non-immersive VR training, validated and bespoke questionnaires, observations, videos, and interviews. Quantitative data were analyzed descriptively. Qualitative data were analyzed using a combined inductive and deductive approach.

RESULTS

Forty-eight care staff completed AR training (n = 19), immersive VR training (n = 21), or non-immersive VR training (n = 8). The immersive VR and AR training had good usability with System Usability Scale scores of 84.40 and 77.89 (of 100), respectively. They had high acceptability, with 95% of staff supporting further use. The non-immersive VR training had borderline poor usability, scoring 67.19 and only 63% would support further use. There was minimal improved knowledge, with an average of 6% increase to the knowledge questionnaire. Average hand hygiene technique scores increased from 4.77 (of 11) to 7.23 after the training. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR/VR. Feasibility and implementation considerations included managerial support, physical space, providing support, screen size, lagging Internet, and fitting the headset.

CONCLUSIONS

AR and immersive VR apps are feasible, usable, and acceptable for delivering training. Future work should explore whether they are more effective than previous training and ensure equity in training opportunities.