To see, or not to see… pathogens in virtual reality hand hygiene training.

Background: ViRTUE, a virtual reality (VR) hand hygiene trainer, offers users the option of visualizing pathogen transfers during virtual patient care either in "real-time" or at the end of a level as a "summary" visualization. In this study, we aimed to evaluate the effect of different timings of pathogen visualization ("real-time" vs "summary") on in-trainer performance and user's immersion.
Methods: The study included first-year medical students undergoing hand hygiene training with ViRTUE, randomized to one of three visualization set-ups: set-up 1 ("on-off-off", with "real-time" visualization at the first level only, and "summary" visualization at level 2 and 3), set-up 2 ("off-on-off"), and set-up 3 ("off-off-off"). In-trainer performance was defined by number of pathogen transmission events (=contaminations) in level 3. The virtual experience of user's (among others: immersion) was assessed with a questionnaire.
Results: 173 medical students participated in the study, with 58, 54, and 61 assigned to set-up 1, set-up 2, and set-up 3, respectively. Users assigned to set-up 3 with "summary" visualization at all levels, performed best with 1.02 (standard deviation (SD) +/- 1.86) contaminations, compared to 2.34 (SD +/- 3.09) and 2.07 (SD +/- 2.52) contaminations of users assigned to the other set-ups. "Summary" visualization at all levels also resulted in higher immersion of users.
Conclusions: "Real-time" visualization of pathogen transmission during VR hand hygiene training with ViRTUE may negatively affect in-trainer performance and user immersion. This emphasizes the importance of pilot testing the effect of VR-based trainings in order to understand their impact on users.