Clear Hands Challenge: A Single-Group Pilot Evaluation of a Digital Serious Game for Surgical Hand Preparation Training in Nursing Students

Clear Hands Challenge! is an HTML5-based digital serious game developed to support the learning and repeated practice of surgical hand preparation procedures among nursing students. The educational content was based on current recommendations for surgical hand preparation and included separate learning activities addressing surgical hand preparation with antimicrobial soap and water and with an alcohol-based surgical hand rub.

The study used a single-group pretest-posttest pilot design. Third-year nursing students who met the eligibility criteria and voluntarily agreed to participate were enrolled. Participants completed a 6-week intervention with 18 planned game sessions, corresponding to at least three sessions per week. The game presented procedural tasks sequentially and provided immediate confirmatory feedback following correct responses and corrective feedback following incorrect responses. Participants were allowed to repeat tasks after receiving feedback. The game generated a formative performance score ranging from 0 to 100; this in-game score was used for educational feedback and was not considered the primary physical performance outcome.

The primary outcome was surgical hand preparation performance demonstrated in a standardized skills laboratory. Physical performance was assessed before and after the 6-week intervention using the researcher-developed Surgical Hand Preparation Skill Checklist. For the primary physical performance assessment, the checklist evaluated surgical hand preparation using antimicrobial soap and water. Participant performances were video-recorded and independently evaluated by two assessors blinded to the assessment time point. Checklist scores were standardized to a 0-100 scale, with higher scores representing better procedural performance.

Intervention exposure and implementation were monitored using system-generated logs, including the number of completed sessions, session duration, completion status, and technical events. Game experience was assessed using the 27-item Gameful Experience Scale (GAMEX). Participants were also asked to report their perceived motivation, perceived ease of learning, and perceived usefulness of the corrective feedback provided by the game.

The study was conducted as a pilot evaluation of the educational intervention and its implementation. The single-group design did not include randomization or a concurrent control group and therefore was not designed to establish the comparative effectiveness of Clear Hands Challenge! or to distinguish the specific effect of the game from other possible influences such as repeated practice, feedback, familiarity with the assessment procedure, or time-related effects.