# Examining the impact of alerting visual stimuli on the effectiveness of practising surgical scrub technique in medical education

## TL;DR

Displaying graphic images of surgical site infections improved medical students' surgical scrub technique by increasing motivation and reducing errors.

## Contribution

This study introduces the use of visual stimuli to enhance surgical scrub training effectiveness, particularly for Generation Z students.

## Key findings

- Group B students exposed to SSI images showed a significant increase in high performers and reduced error rates.
- 60.3% of Group B students found the SSI images motivating for proper hand hygiene.
- 44.4% of Group B students recommended more frequent use of the Semmelweis Scanner for training.

## Abstract

Inadequate surgical scrubbing is a key risk factor for surgical site infections (SSIs). Visual documentation of errors during training enhances learning while the Semmelweis Scanner provides objective quality control. This study hypothesized that displaying graphic images of severe SSIs in the scrub room would improve students’ surgical scrub discipline and effectiveness. By serving as a stark visual reminder of the consequences of poor hand hygiene, this approach was expected to enhance adherence to proper scrubbing protocols, especially among Generation Z students, who respond well to multisensory learning strategies.

The study involved 121 medical students in the “Basic surgical techniques” course during the 2nd semester of 2023/2024. The last phase of the surgical scrub was performed with hand disinfectant containing fluorescein. Participant identification utilized Radio Frequency Identification (RFID). Measurements were taken 4 times with Semmelweis Scanner device (HandInScan Zrt.), examining error localization and proportion relative to the total hand area.

Students were divided into two groups: Group A (n = 58) performed scrubs without visual stimuli, while Group B (n = 63) was exposed to SSI images during two of four sessions. Performance was categorized as low, medium, or high based on error rates. Group B completed a questionnaire evaluating the images’ impact and their motivation for proper hand hygiene.

Between measurements 2 and 3, Group B (with visual stimuli) showed a significant increase in high performers (24 to 42) and a reduced error rate (11.98 ± 5.12% to 4.77 ± 3.06%). Of Group B’s 63 students, 60.3% found the SSI images motivating, 34.9% were neutral, and 4.8% found them disturbing or distracting. All Group B students acknowledged hand hygiene’s critical role in infection prevention. Additionally, 44.4% recommended more frequent Semmelweis Scanner use, and 36.5% suggested additional visual tools to enhance scrubbing efficiency.

Graphic SSI images as visual stimuli significantly improved surgical scrub techniques by boosting motivation and accelerating the learning curve. This method supports the prevention of healthcare-associated infections and enhances patient safety. Due to its effectiveness, the approach was integrated into the “Basic surgical techniques” course starting the following semester, with potential for broader application in medical education.

The online version contains supplementary material available at 10.1186/s12909-025-08479-8.