The last place someone would want to acquire a new infection would be the hospital, or any healthcare setting for that matter. It is akin to going in to get one health issue addressed and coming out with an altogether new one to deal with. Yet, and as surprising as it may sound, healthcare settings are a common source of infections, and those too of often the dangerous kind involving resistant organisms.
The proper term for infections acquired in healthcare settings is healthcare-associated infections or HCAIs. In the past, they have also been called nosocomial infections as well as hospital-acquired infections. HCAIs can potentially involve any healthcare setting, including
- Outpatient clinics
- Family clinics
- Dental practices
- Long-term care
- Home care
- Nursing homes
- Ambulatory care
To understand the magnitude of the problem here in the UK, let’s go over some staggering statistics:
- Each year in England, about 300,000 patients acquire HCAIs while receiving care within the NHS.
- HCAIs cost the NHS over £1 billion every year.
The situation is no different in the US or across the rest of Europe:
- According to the US Center for Disease Control and Prevention, almost 1.7 million hospitalised patients annually acquire HCAIs and more than 98,000 of them die due to the acquired infection.
- According to the Agency for Healthcare Research and Quality, HCAIs are one of the top 10 causes of death in the US.
- In Europe, up to 9% of admitted patients are affected by HCAIs.
When one sees the enormity of the problem, it becomes easy to understand why infection control in healthcare settings is so important and a top priority for medical providers and practices all the way up to healthcare policymakers and regulators. With this background, we can now discuss how infection control is a significant hindrance to VR adoption in medical applications.
Infection Control: A Threat to Medical Virtual Reality Adoption
Why is VR an infection control issue in the first place? In short, because the headsets are shared. Remember, the disposable syringe was a medical breakthrough since it eliminated the risk of infection associated with reused syringes. Medical items and instruments that are used on patients are either disposable so that they are discarded after a single use or go through a rigorous process of sterilisation before being shared by other patients. For example, surgical instruments are autoclaved to ensure their sterility.
VR headsets, also known as head-mounted displays or simply HMDs, need to be properly sanitised before and after each use. The problem here is that the headsets were never developed with a medical utility in mind. For VR tech companies, the focus market demographic has always been gamers, and not patients. Headsets come in all different forms of fancy designs such as furry headsets and foam face masks that would be ideally suited to serve as havens for germs. So, before anything else, a VR headset to be used in medical settings should be selected on the basis of how easy and practical it would be to keep it sanitised.
VR Infection Control—An Interesting Case Study
We worked with a university in South Wales to evaluate the effectiveness of sanitising VR headsets. Researchers at the university conducted multiple tests on several VR HMDs. The following headsets were tested:
- Pico G2 (25 trials)
- Pico Neo (25 trials)
- Samsung Gear VR (20 trials)
- Oculus GO (20 trials)
Method for testing each headset:
Measuring the contamination:
- Using sterile scissors and aseptic technique throughout, the tip of each cotton swab was cut into a 1.5 ml sterile Eppendorf tube containing 1 ml PBS.
- The solution was centrifuged for 10 seconds and then 250 µl of it was pipetted onto a blood agar plate, using a sterile spreader to inoculate the whole surface of the agar.
- The procedure was repeated for each swab sample and each plate was labelled accordingly.
- The plates were incubated for 48 hours at 37°C.
- Colony counts were then recorded for each plate to measure the level of contamination at that stage.
Results for the HMDs:
of bacteria killed
by alcohol wipes
|Average number of
colonies on headset
|Average number of
species on headset
|Samsung Gear VR||97%||37||2|
Below is a graphical depiction of these results:
Since the Pico Neo headset seemed to be the best headset for clinical settings out of those tested because it was collecting the least amount of contamination, some further tests were run on it and the following results were obtained:
Average number of colonies on the plastic casing = 27
Average number of colonies on the mask insert = 14
Average number of colonies on the headrest/strap = 75
Average number of colonies in the crevices = 2
The area with the most contamination was the headrest/strap as this was the area in most contact with the face. Having said that, it cleaned really well.
The plastic casing and mask insert picked up less contamination, most likely because the headset wasn’t touched much during use as it fitted securely. Also, the mask wasn't very tight to the face, so it didn't seem to pick up much contamination either.
Very little contamination was found in the crevices (under the mask), and in most instances the colony count was 0. Probably because it is so tightly sealed against the plastic and users have no reason to lift it.
Another finding was that the handheld UV device killed an average of 71% of bacteria on the G2 headset compared to an average of 95% killed by the fume cupboards UV, demonstrating that the latter was clearly much stronger.
Interpretation and Implications:
The results indicate that the Pico Neo headset picks up the least amount of contamination during use. The Pico Neo and G2 both responded really well to the alcohol wipes, which almost completely eradicated the contaminants. It was also quicker to clean them with the wipes than with UV alternatives.
Sanitisation effectiveness results for some popular HMDs were as follows:
Pico G2 – 99%
Pico Neo – 98%
Samsung Gear VR – 97%
Oculus GO – 93%
The headsets that came out with the best results were the Pico Neo and G2. On the other hand, certain headsets currently being used by some healthcare institutions failed the testing and in turn would fail any internal infection control process.
From what we learned from this research, we devised a protocol that would ensure 99% infection control compliance for our own DR.VR headset.
Infection Control Compliance Recommendations for DR.VR
- Wipe headset with cleansing wipes. Focus on all areas of the VR headset including
- Face mask (inner and outer)
- Main headset itself with particular focus around the control buttons and underneath (near the nose guard)
- Use a disposable VR sanitary face mask to create a barrier between the skin and the face mask (this is to ensure any cleansing residue is not exposed to the patient’s skin).
- Allow patient to experience VR.
After removing the VR headset from the patient:
- Wipe headset with cleansing wipes, all over the headset, including face mask, straps, and headband.
- Store the headset in the DR.VR carry case or the headset is ready for use again.
REFERENCES1. NICE: Infection prevention and control. Quality standard [QS61]. Published date: April 2014. Retrieved from https://www.nice.org.uk/guidance/QS61/chapter/introduction
2. Mackley A., Baker C., Bate A. Raising standards of infection prevention and control in the NHS. Commons Library Debate Pack. Number CDP-2018-0116, 14 May 2018. Retrieved from http://researchbriefings.files.parliament.uk/documents/CDP-2018-0116/CDP-2018-0116.pdf
3. Haque M., Sartelli M., McKimm J., Bakar M.A. Health care-associated infections—An overview. Infect. Drug Resist. 2018;11:2321–2333. doi: 10.2147/IDR.S177247.