Overview
Hand hygiene remains one of the most effective defenses against health care–associated infections (HAIs). This quasi-experimental study investigates whether a brief virtual reality (VR) training program can rapidly improve correct hand hygiene execution among two key groups in Colombia: health care assistants (HCAs) and informal caregivers (ICs) of dependent patients. The goal was to assess immediate post-training performance and the feasibility of implementing VR in real-world settings.
Context and Rationale
Adherence to proper hand hygiene varies widely by country and setting, contributing to the burden of HAIs. In Colombia, nosocomial infections and related costs underscore the need for scalable, effective training for those delivering care outside traditional clinical environments. VR-based learning offers immersive, feedback-rich practice that can accelerate skill acquisition and standardize technique across diverse care settings.
Study Design and Methods
The study followed a one-group pre-posttest design with anonymized paired data. Participants included 136 HCAs and 165 ICs at seven private hospitals in Bogotá. After baseline assessments, participants received a VR-based hand hygiene intervention using Meta Quest 2 headsets in a dedicated VR room, guided by a facilitator. The program included a 1 minute 27 second instructional video and a 5-step, WHO-aligned handwashing sequence (palms rub, backs of hands, interdigital spaces, fingertips/nails, thumbs rotation). Real-time feedback occurred during and after attempts, with up to three practice rounds. Knowledge was measured with a 5-item MCQ, and performance was judged against a 5-step rubric for correct execution.
Outcome Measures
Primary outcome: proportion of participants achieving correct hand hygiene immediately post-training (pass/fail by completing all five steps without omissions or mis-sequencing). Secondary outcomes: error counts, time spent washing, knowledge scores, self-reported confidence, and VR training acceptability/usability. Data were analyzed with mixed-effects models and paired comparisons, using a 5% significance level.
Key Findings
At baseline, 26.6% of HCAs and 9.9% of ICs performed correct hand hygiene per guidelines. Post-training, adherence surged to 97.9% among HCAs and 95.9% among ICs (P<0.001 for both groups). Absolute gains reached +71.3 percentage points for HCAs and +86 percentage points for ICs, with odds ratios indicating substantially higher post-training correctness. Time spent washing increased modestly (HCAs: 37.1 to 46.6 seconds; ICs: 36.5 to 48 seconds). Common pretraining errors, such as fingertip coverage, thumb cleaning, and nail care, dropped to near zero after VR training.
Knowledge, Acceptability, and Feasibility
Knowledge scores improved modestly but significantly, suggesting that the main benefit of VR lies in execution rather than declarative knowledge. Acceptability was high: 76.6% of HCAs and 90.1% of ICs rated the training as very or extremely useful. No adverse events were reported, although a small subset of ICs experienced motion-tracking difficulties requiring guidance. The training was brief, with on-site onboarding taking only a few minutes, and four-stage active learning cycles supported by immediate corrective feedback.
Interpretation and Implications
The study shows that a concise VR-based hand hygiene program can produce large, immediate improvements in technique and adherence among HCAs and ICs. The gains align with WHO recommendations and exceed adherence improvements typically seen with traditional or other active-learning formats. VR training appears to compress the skills-acquisition curve, offering a scalable, engaging approach that can be integrated into multimodal hand hygiene bundles to reduce HAIs. The durability of these gains and their impact on actual infection rates warrant future randomized or controlled studies and longer follow-up.
Limitations and Future Directions
Limitations include the lack of a control group, potential selection bias from snowball sampling, and short follow-up. Attrition and data quality challenges also warrant attention in future work. Economic evaluations are needed to balance upfront VR costs with downstream infection-control savings. Subsequent research should explore long-term retention, cost-effectiveness, and adaptation to other home-care and community settings.
Conclusion
Brief VR-based hand hygiene training proves to be highly effective and well-received among health care aides and informal caregivers in Colombia. By standardizing technique, providing real-time feedback, and delivering content in an accessible format, VR has the potential to enhance infection prevention practices across care environments, ultimately contributing to safer patient care and reduced transmission of infections.
