Ensuring a clean healthcare environment is essential for the safety of healthcare personnel (HCP) and patients, and for reducing the risk of healthcare-associated infections (HAIs). This involves the cleaning and decreased levels of disinfection of the non-critical portable medical equipment (PME). PME is often improperly cleaned, with contamination rates from 25 to 100%. Contributing factors include HCPs’ limited knowledge of their role in HAI transmission and the lack of targeted education.
Virtual reality (VR) is emerging as a novel training modality for infection prevention and control (IPC), aiming to enhance practices such as sharps injury prevention, appropriate use of personal protective equipment (PPE) kits, and hand hygiene. VR includes some challenges, like identifying objective improvements and overcoming implementation barriers in HCP performance and competency.
A recent study published in Infection Control & Hospital Epidemiology described the development and evaluation of a VR IPC training module as a part of a quality enhancement project. This module was designed to address gaps in PME disinfection and cleaning by simulating realistic healthcare scenarios.
A multidisciplinary team created a VR training module using the EducationXR platform and head-mounted displays (HMDs), which allow users to navigate a simulated inpatient healthcare environment. The module was initially piloted at seven healthcare facilities following a plan-do-study-act (PDSA) model. Semi-structured interviews were conducted in English and Spanish via videoconferencing to gather participant feedback. A senior data analyst (EAB) led the qualitative analysis with three independent coders performing double coding of the interview transcripts. Inter-rater reliability was manually assessed, and discrepancies were resolved collaboratively. Consensus was achieved on the emerging codes and key themes, which informed revisions to both the VR IPC module and supporting implementation materials before launching Phase 2 (P2). New participants tested the revised module, providing feedback through interviews or online surveys, and were compensated with a $25 gift card. The study was reviewed and designated as non-human subjects research (NHSR) by the MGB Institutional Review Board (2023, ID 863).
Between January and March 2024, a group of 31 individuals from three healthcare sites contributed to the development of a VR-IPC training module. The module went through revisions from April to June 2024. Subsequently, from July to November 2024, the revised module was tested by 44 participants from four additional sites. Most participants were nurses with limited or no previous exposure to VR technology.
During Phase 1 (P1), participants appreciated the realistic and immersive environment and the opportunity to interact with virtual objects. Many experienced physical discomforts like headaches, eye strain, dizziness, and nausea. Some also expressed frustration or anxiety because of the limited visibility of their physical surroundings. Additional challenges involved difficulty in operating controllers, manipulating virtual PME, and using the virtual gloves. Moreover, about half of the participants found the module’s instructions content unclear.
In response, Phase 2 (P2) involved technical enhancements to the module. These included reprogramming to support alternative controller inputs, reducing required travel distances with PME, incorporating visual cues for glove interaction, and simplifying the instructional content. New implementation tools were also developed to support HMD setup and module delivery.
As part of this quality improvement (QI) initiative, the revised VR IPC module was deployed across multiple healthcare settings, which led to improved user experience and fewer technical issues, such as blurred visuals and malfunctioning controllers. Overall, participants expressed increased engagement. Nonetheless, the study had limitations, such as a small, predominantly nursing-based sample and the lack of a comparative control group.
These findings underscore the importance of iterative piloting and continuous refinement using the PDSA cycle to improve educational tools. Future research will focus on assessing the improvements in user knowledge, skills, and competency after technical refinements aimed at reducing physical discomfort and enhancing usability.
Reference: Barreto EA, Jerry MS, GarcĂa V, et al. Getting real clean: a virtual reality training pilot study for cleaning and low-level disinfection of portable medical equipment. Infect Control Hosp Epidemiol. 2025. doi:10.1017/ice.2025.89
