Improving Hand Hygiene Skills Using Virtual Reality: Quasi-Experimental Study.

Abstract

Background: Hand hygiene is a critical strategy for preventing health care-associated infections (HAIs) and reducing health care costs. However, adherence remains low, particularly among health care assistants (HCAs) and informal caregivers (ICs), who often lack formal training. Virtual reality (VR) delivers standardized, immersive practice with active learning and real-time feedback. It has shown favorable effects on skill execution and acceptability in training paramedics and caregivers. To our knowledge, VR has not been systematically applied to train World Health Organization (WHO)-aligned hand hygiene techniques. Given its portability and suitability for brief, repeatable drills, VR is a plausible solution to upskill HCAs and ICs in both hospital and home-care settings.

Objective: This study aims to assess the immediate training effectiveness and implementation feasibility of a brief VR-based hand hygiene program for HCAs and ICs in Colombia. We quantified pre-post changes in correct execution (primary outcome), timing, errors, and knowledge. Success was defined a priori as achieving ≥75% correct execution after training, consistent with adherence levels associated with HAI reductions when embedded in WHO-aligned bundles in prior studies.

Methods: In this quasi-experimental, one-group pretest-posttest study, 215 participants (94 HCAs, 121 ICs) completed up to three 15-minute VR training sessions with real-time feedback on hand hygiene technique following the WHO recommendations for hand hygiene. Data were collected at baseline (pre) and immediately after the VR intervention (post). Variables assessed included correct execution (primary; binary), error counts, timing adequacy, knowledge assessment, and acceptability.

Results: Correct hand hygiene performance increased from 26.6% to 97.9% among HCAs (95% CI 92.6-99.4; P<.001) and from 9.9% to 95.9% among ICs (95% CI 90.7-98.2; P<.001), with paired odds ratios of 34.5 (95% CI 8.46-140.72) and 21.8 (95% CI 8.90-53.43), respectively. Wide intervals were driven by the very small number who performed worse after training. Timing adequacy improved significantly in both groups, reaching 46.6 (SD 6.7) and 48 (SD 6.6) seconds, respectively (P<.001). Common errors, such as insufficient fingertip coverage and incomplete thumb cleaning, were reduced to near 0 (P<.001). Knowledge scores also improved significantly in both groups, and VR training was rated as "very useful" or "extremely useful" for skill acquisition.

Conclusions: VR training significantly improved hand hygiene technique and knowledge. The high acceptance rates observed suggest that these technologies can effectively enhance infection prevention skills in undertrained populations, supporting broader adoption in health care education. Because this brief, portable, and highly acceptable intervention can be embedded in routine onboarding, refresher microdrills, and caregiver education-including home care and resource-constrained settings-VR is well-suited for scale-up. When implemented within WHO-aligned multimodal bundles and with adherence sustained above pragmatic thresholds, this approach may contribute to downstream reductions in HAIs. Definitive confirmation will require a controlled effectiveness trial.

Trial registration: ClinicalTrials.gov NCT07005544; https://clinicaltrials.gov/study/NCT07005544.