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Teaching best practice in hand hygiene: student use and performance with a gamified gesture recognition system
  1. Caroline Mosley,
  2. John R Mosley,
  3. Catriona Bell,
  4. Kay Aitchison,
  5. Susan M Rhind and
  6. Jill MacKay
  1. Veterinary Medical Education Division, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, UK
  1. Correspondence to Caroline Mosley; caroline.mosley{at}


The use of an automated gesture recognition system to teach the commonly adopted, seven-stage hand hygiene technique to veterinary undergraduate students was evaluated. The system features moderate gamification, intended to motivate the student to use the machine repeatedly. The system records each handwash stage, and those found to be difficult are identified and reported back. The gamification element alone was not sufficient to encourage repeated use of the machine, with only 13.6 per cent of 611 eligible students interacting with the machine on one or more occasion. Overall engagement remained low (mean sessions per user: 3.5, ±0.60 confidence interval), even following recruitment of infection control ambassadors who were given a specific remit to encourage engagement with the system. Compliance monitoring was introduced to explore how students used the system. Hand hygiene performance did not improve with repeated use. There was evidence that the stages—fingers interlaced, rotation of the thumb, rotation of the fingertips and rotation of the wrists—were more challenging for students to master (p=0.0197 to p<0.0001) than the back of the hand and of the fingers. Veterinary schools wishing to use such a system should consider adopting approaches that encourage peer buy-in, and highlight the ability to practise difficult stages of the technique.

  • disease control
  • preclinical education
  • clinical practice
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  • Funding This study was funded by the University of Edinburgh, Principal’s Teaching Award Scheme (SureWash December 2015).

  • Competing interests None declared.

  • Ethics approval Ethical review was performed and approval granted by the Human Ethics Review Committee of the host institution (reference: HERC_82_17). Students were made aware of the trial during lectures, that using the machine would support their cohort ambassador and that data from the machine would be used in the ensuing evaluation. If students did not wish to join the trial, they could opt not to use the machine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

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