They say practice makes perfect. But as any amateur golfer or tennis player will know, practice is not the whole story. This blog discusses the learning science that is used by expert coaches and aims to show how we can help learners improve their infection control skills and retain them for longer. Fundamentally, we must consider how we teach hand hygiene to help achieve hand hygiene compliance.

The learning science

Before we dive into solutions, let’s review the science of learning. K. Anders Ericsson was a global leader in learning research, especially medical skills. His work was the inspiration for Malcolm Gladwell’s book “Outliers”. The core of his approach, called “deliberate practice”, is that learning is most effective when we get immediate feedback from a coach, and we focus on reducing the errors we make on each interaction. Benjamin Bloom, one of the most famous educationalists in history, identified that everyone’s learning is different. His theory, called “mastery learning” emphasizes the need for each learner to master each skill level before moving on to the next level of complexity and this should be at the pace that best suits each learner. Recent neuroscience studies have confirmed the notion of muscle memory and that short frequent training sessions are better than one-off longer training sessions. A very short session, even just a few minutes, undertaken every day for a few weeks leads to much better skill retention than a one-off long training session.

Designing the ideal hand hygiene learning programme

While using traditional training tools such as UV glow boxes are good for motivation, they don’t explain to learners what they did wrong or how to modify their practice. Thus, we are not getting deliberate practice or mastery learning. The glow-box approach uses gel coverage as a proxy for effectiveness, but scientific results show it is actually a poor proxy for microbiological effectiveness as friction is needed. (1)

If we follow the learning science, the ideal hand hygiene training programme will teach each pose separately, give coaching feedback immediately (deliberate practice), build skills progressively as each skill level is attained (mastery learning) and be available 24-7 to allow for short burst learning (neuroscience). Clearly, we can’t have a hand hygiene trainer permanently available to coach people in hand hygiene practice, but with learning technology and artificial intelligence (AI), this science-based approach to learning is possible.

Using AI to enable science-based approaches to learning

So how can we incorporate real-time feedback into training? One solution is the use of digital education tools like virtual reality (VR) and augmented reality (AR) to provide real-time feedback on technique. For example, during surgical training, learners can use learning tools to practice surgical procedures and receive feedback on their technique in real time. They can then make adjustments and continue practicing until they achieve mastery.

For hand hygiene, gesture recognition technology allows the learning system to provide feedback on each step of hand hygiene. This technology uses sensors to track the movements of the learner’s hands and provide feedback on proper hand hygiene technique. For example, learners can practice washing their hands while wearing sensors, and the technology can provide feedback on which areas they may have missed or not washed thoroughly.

Digital education tools can facilitate this type of training by allowing learners to practice skills in short, focused bursts. For example, a learner could practice a specific surgical technique for 10-15 minutes at a time using VR, receiving real-time feedback on their performance. They could then repeat this practice session multiple times throughout the day, leading to faster learning and improved retention.


As an infection control nurse, you understand the importance of proper technique when it comes to preventing the spread of infection. Real-time corrective feedback can be a powerful tool for improving training outcomes and ensuring that learners master physical skills.



Gozdzielewska, L., Price, L., McAloney, K., Lang, S., & Reilly, J. (2020). Is hand surface coverage a good measure of hand hygiene effectiveness? Access Microbiology, 2(2).