Effectiveness of VR on the Sustainability of Hand Hygiene Compliance: School-based RCT With 10-month Follow-up

NCT07659340 | Recruiting DMC

• 1 other identifier: 23244181
• Study Type: interventional
• Target: 500
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to evaluate the effectiveness of a VR intervention on teaching handwashing skills which are promoted by the Centre for Health Protection, Department of Health, HKSAR. A 7-step handwashing approach will be taught through a customized VR game in secondary schools in Hong Kong. Participant's handwashing skills and prolonged effects on handwashing habits and hygiene level will be assessed. The main questions it aims to answer are:

• Does an intervention of our VR handwashing game enhance handwashing skills amongst junior secondary students?
• What are the factors hinder or enhance students' learning of handwashing skills in the intervention? Participating students will be assigned into 3 groups. Each group will receive two sessions of educational training with different kinds of intervention throughout one school year (9 months). The first intervention group will participate in two VR-game sessions on handwashing skill; the second intervention group will participate in one VR-game session and one video session about handwashing; the baseline group will participate in two sessions of other VR activities unrelated to hand hygiene and view a handwashing skill poster. The research will compare the handwashing performance between the three groups. Participants will:
• participate into a VR handwashing game intervention, or a video-based intervention, or placebo VR activities as stated hereinafter;
• perform handwashing in the VR game, and their hand-motion data will be captured;
• participate a UV lighting test after handwashing away fluorescent lotion; and,
• fill up questionnaires

Conditions

Hand; Hygiene Practices and Knowledge

Keywords

Hand Hygiene; Virtual Reality; Hand Disinfection; Educational

Outcome Measures

Primary Outcomes (1)

• Hand-imaging Data

  Ultraviolet-sensitive fluorescent lotion (e.g., Glo Germ™) will be applied on participants' hands thoroughly to simulate full contamination (e.g., germs and pathogens) on hands. Then participants wash their hands. The areas where lotion has been washed out are considered as 'decontaminated'. The participants will put their washed hands in a black box with an Ultraviolet-A (365nm) lighting system. Both palms and dorsa of left and right hands will be photographed.

  Hand-imaging data will only be collected before the 1st intervention and at the end of the data collection period (about 9 months after the 1st intervention).

Secondary Outcomes (3)

• Knowledge on Hand Hygiene and Handwashing

  This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).

• Handwashing Habit

  This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).

• Attitude and Intention

  This measurement will be collected through questionnaire pre-intervention, immediately after 1st intervention, after 2nd intervention (5 months after 1st intervention) and in the follow-up survey (9 months after 1st intervention).

Study Arms (3)

Intervention 1

EXPERIMENTAL

Participants who attend two VR game sessions

Other: VR Handwashing Game (2 sessions)

Intervention 2

EXPERIMENTAL

Participants who attend one VR game session and one video-based education session

Other: VR Handwashing Game (1 session) + Video on hand hygiene (1 session)

Baseline Group

NO INTERVENTION

Participants who attend two non-hand hygiene related VR activity sessions

Interventions

VR Handwashing Game (2 sessions) OTHER

The intervention will be a VR game taught about the '7-Steps approach' of hand-washing promoted by Centre for Health Protection, HKSAR. The game is comprised of two parts: Training Mode and Challenge Mode. In Training Mode, students will be guided with text and voice feedback. A pair of 'ghost hands' will demonstrate what to do. Students follow the movements of the 'ghost hands' to complete the handwashing tasks. In the Challenge Mode, students are requested to perform all the steps at once by their own memory, hints will be given only when they encounter setback in an assigned duration. Trained facilitators will teach participants how to use the VR devices and provide briefing sessions on how to play the game. For the Intervention Group 1, they will play the game in two separate sessions (about 4 months between the two sessions).

Intervention 1

VR Handwashing Game (1 session) + Video on hand hygiene (1 session) OTHER

For Intervention Group 2, participants will attain one VR game session and 1 video-instructed session.

Intervention 2

Eligibility Criteria

• Age: 12 Years - 15 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17)

You may qualify if:

• Hong Kong secondary school students studying junior forms

Sponsors & Collaborators

• The University of Hong Kong: lead

Study Sites (1)

School of Future Media, The University of Hong Kong

Hong Kong, Hong Kong

RECRUITING

Related Publications (19)

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• Gasteiger N, van der Veer SN, Wilson P, Dowding D. 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. J Am Med Inform Assoc. 2023 Dec 22;31(1):45-60. doi: 10.1093/jamia/ocad200.

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• Eichel VM, Brandt C, Brandt J, Jabs JM, Mutters NT. Is virtual reality suitable for hand hygiene training in health care workers? Evaluating an application for acceptability and effectiveness. Antimicrob Resist Infect Control. 2022 Jun 25;11(1):91. doi: 10.1186/s13756-022-01127-6.

  PMID: 35752839 BACKGROUND

• Galvan Debarba H, Bovet S, Salomon R, Blanke O, Herbelin B, Boulic R. Characterizing first and third person viewpoints and their alternation for embodied interaction in virtual reality. PLoS One. 2017 Dec 27;12(12):e0190109. doi: 10.1371/journal.pone.0190109. eCollection 2017.

  PMID: 29281736 BACKGROUND

• Asadzadeh A, Samad-Soltani T, Rezaei-Hachesu P. Applications of virtual and augmented reality in infectious disease epidemics with a focus on the COVID-19 outbreak. Inform Med Unlocked. 2021;24:100579. doi: 10.1016/j.imu.2021.100579. Epub 2021 Apr 27.

  PMID: 33937503 BACKGROUND

• Mira J, Gonzalez M, Villalba C, Guerra L, Ramirez-Moya Y, Hernandez J, Moya O, Pineda L, Perez-Esteve C. Improving Hand Hygiene Skills Using Virtual Reality: Quasi-Experimental Study. J Med Internet Res. 2025 Oct 7;27:e78882. doi: 10.2196/78882.

  PMID: 41057041 BACKGROUND

• The Centre for Health Protection, Department of Health, HKSAR. Proper Hand Hygiene. The Centre for Health Protection, Department of Health, HKSAR; 2026. https://www.chp.gov.hk/en/healthtopics/content/460/19728.html

  BACKGROUND

• Faruk Karabulut O, Celikcan U, Ellahi B, Dikmen D. Training of food handlers on handwashing using a virtual reality environment is more effective than traditional training approaches in a randomized trial. Int J Environ Health Res. 2025 Aug;35(8):2067-2078. doi: 10.1080/09603123.2024.2425781. Epub 2024 Nov 10.

  PMID: 39522117 BACKGROUND

• Stuart JP, Gannon PR, Dotto VR, Regina R, Mumma JM. Visualizing the WHO "My Five Moments for Hand Hygiene," framework: A virtual reality training program for improving hand hygiene adherence among nurses. Am J Infect Control. 2025 May;53(5):576-581. doi: 10.1016/j.ajic.2025.01.007. Epub 2025 Jan 15.

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• World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. World Health Organization. https://www.who.int/publications/i/item/9789241597906.com

  BACKGROUND

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  BACKGROUND

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  PMID: 26471110 BACKGROUND

• World Health Organization. Progress on drinking water, sanitation and hygiene in schools: Special focus on COVID-19. 2020a [cited 2026 June 15]. Available from https://data.unicef.org/resources/progress-on-drinking-water-sanitation-and-hygiene-in schools- special-focus-on-covid-19/

  BACKGROUND

• Jatrana S, Hasan MM, Mamun AA, Fatima Y. Global Variation in Hand Hygiene Practices Among Adolescents: The Role of Family and School-Level Factors. Int J Environ Res Public Health. 2021 May 7;18(9):4984. doi: 10.3390/ijerph18094984.

  PMID: 34067142 BACKGROUND

• Miron O, Yu KH, Wilf-Miron R, Kohane I, Davidovitch N. COVID-19 infections following physical school reopening. Arch Dis Child. 2021 Jul 19;106(8):e34. doi: 10.1136/archdischild-2020-321018. No abstract available.

  PMID: 33288536 BACKGROUND

Study Officials

• King-wa Fu, Professor

  School of Future Media, The University of Hong Kong

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Siu-lun Chow, PhD

CONTACT

+852 3917 1155; chowcass@hku.hk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: CARE PROVIDER, OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Model Details: A 3-arm randomized controlled trial will be adopted. 369 students will be assigned into 3 groups which will be randomly assigned on class-basis. Each group will receive two sessions of educational training with different kinds of intervention throughout one school year (9 months). The first intervention group (full-intervention) will participate in two VR-game sessions on handwashing skill; the second intervention group (half-intervention) will participate in one VR-game session and one video session about handwashing; the baseline (control) group will participate in two sessions of other VR activities unrelated to hand hygiene and view handwashing promotion poster.

Study Record Dates

• First Submitted: June 15, 2026
• First Posted: June 22, 2026
• Study Start: March 1, 2026
• Primary Completion (Estimated): August 30, 2027
• Study Completion (Estimated): August 30, 2027
• Last Updated: June 24, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

HK (1)