Effect of brief virtual reality training on first-attempt hand-disinfection performance in an OSCE: A randomized controlled trial

Background Reliable hygienic hand-disinfection is essential for infection prevention and control. It remains unclear whether a brief immersive VR training module improves objectively assessed procedural performance compared with conventional instruction. This single-center, parallel-group randomized controlled trial examined first-opportunity hand-disinfection performance in an Objective Structured Clinical Examination (OSCE) after VR training versus a video control. Methods In 2025, first-year nursing students at a single Austrian University [University name withheld for anonymity] were randomized (1:1) to a 20-minute immersive VR module (contamination visualization feedback) or a time- and headset-matched instructional video control (no interactivity). Randomization used block allocation (blocks of six); instructions were standardized via audio playback. Three days later, students completed a routine five-station OSCE. Hygienic hand-disinfection was required at the beginning of each of five OSCE stations and was documented within routine station checklists. Hand-disinfection ratings from the five stations were extracted from routine OSCE checklists and coded (0 = incorrect, 1 = partially correct, 2 = correct). The preregistered primary endpoint was station 1 performance. The primary hypothesis was tested with adjusted proportional-odds regression (age, gender, hygiene course grade), all other analyses were exploratory. Results Of 128 randomized students (VR n = 65; control n = 63), primary outcome data were complete; one covariate value was missing, yielding N = 127 for adjusted models. At station 1, fully correct performance occurred in 52/65 (80.0%) in VR versus 15/63 (23.8%) in control. VR training was associated with markedly better first-opportunity performance (adjusted OR = 11.16, 95% CI [4.95, 25.14], p = 5.9×10⁻⁹), supported by sensitivity analyses (pass/fail adjusted OR = 6.06, 95% CI [1.84, 19.92]; linear b = 0.77). Exploratory analyses suggested higher performance across stations, with group differences varying by station. No harms or adverse events were observed during the trial. Conclusion A brief immersive hand-disinfection training module with contamination visualization improved first-opportunity OSCE hand-disinfection performance compared with a headset-delivered video control. This suggests that brief, feedback-rich immersive training may support immediate procedural readiness under standardized assessment conditions. Trial registration This study was preregistered within a larger longitudinal project and later registered as a stand-alone study in the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/3B6SC).