Table 1 CRe-DEPTH criteria

1. Aim or objectives of the training

The aim of this study was to compare the VR technology with a conventional lecture in terms of user acceptance and clinical outcome towards hand hygiene

2. Underlying theoretical framework

Nosocomial infections pose an enormous threat to patient safety. Poor hand hygiene is one of the key factors in the spread of germ in healthcare and continuous training is one of the most effective measures in improving the adherence. VR offers a new approach in training by giving an individual, fun, and true-to-life experience as well as offering the opportunity of training 24/7

3. Developmental process

The VR hand hygiene scenario was developed and provided by the company Essity. The compared lecture was closely related to the VR training in content and duration of the lesson

4. Target population and setting of the training

Target population was health-care workers of 3 wards at a tertiary care hospital in Germany

5. Educational resources

We used 4 VR headsets with the installed VR application, a teaching room with 4 swivel chairs and a technical instructor. The lecture was hold as a classic slide show presentation by beamer in a fully seated room

6. Content of the intervention

VR training: Initially a short explanation of the correct technique of hand hygiene is given by means of illustrations. After choosing whether the participants profession is nurse or doctor, the first out of three virtual patient rooms can be entered. Finally, various situations take place in which tasks relating to the topic of hand hygiene are to be solved. In particular, the participant will have to decide in different clinical situations whether hand hygiene or the wearing of gloves is necessary, as well as to choose the correct sequence of these. The program immediately gives an alarm if an indication has been forgotten. After completion of the scenarios, the app directly evaluates the situations and gives feedback regarding the correct application of hand hygiene and glove use

Lecture: A slide show presentation with the correct technique, indications for hand hygiene, and practical cases similar to those in the VR scenario was presented

7. Format

To assess satisfaction and effectiveness of both educational methods, we compared the different approaches in 3 wards. In a two-month interval both trainings were offered in ward 1 and 2 in a crossover design. While ward 1 received the VR training first, ward 2 started with the lecture

To increase number of participants a further ward received VR training. Both, the VR scenario and the lecture had a training duration of about 20 min

8. Didactic methods of training

Simulation of scenarios by VR or lecture with slide show were applied

9. Tailoring of the training

In the VR intervention groups, the training can be tailored to profession and speed. The generation of a result overview also provides individual feedback at the end of the training. The lecture groups received all the identical lesson, no differences were made between professions

10. Providers of the training

The introduction and technical support of the VR training was provided by IPC physicians and technical staff. Lecture was provided by IPC physicians

11. Measured outcomes

Primary outcome was the HCW satisfaction. Secondary outcomes were hand rub consumption and compliance to indications for hand hygiene as proposed by WHO [16]

12. Applied assessment method, including its validity and reliability

HCW satisfaction was measured after intervention using a standardized questionnaire with Likert-Scale. Hand rub consumption was measured continuously. Compliance observations were made before and after each intervention. To exclude acute and only short-lived behavioral adjustments compliance was measured after approximately 2-weeks post intervention. It was performed by a research assistant not included in further processes of the trial to guarantee blinding