Using Ozires, a Humanoid Robot, to Continuing Education of

Healthcare Workers: A Pilot Study

Bráulio Roberto Gonçalves Marinho Couto

, André Luiz Silva Alvim

Isabela Lorena Alfenas da Silva

, Mário Marcos Brito Horta

Joaquim José da Cunha Júnior

and Carlos Ernesto Ferreira Starling

Instituto de Engenharia e Tecnologia (IET), Centro Universitário de Belo Horizonte - UniBH,

Av. Professor Mário Werneck, 1685, Belo Horizonte, Brazil

Serviço de Controle de Infecções Hospitalares (SCIH), Hospital Lifecenter, Av. do Contorno 4747, Belo Horizonte, Brazil

Keywords: Hand Disinfection, Handwashing, Continuing Education, Robot Tutors.

Abstract: Continuing education of health professionals in relation to hand hygiene practices or other issues is a

challenge for health services. How to take a healthcare worker from his work sector, for example, Intensive

Care Units (ICUs) or Operating Room, to give him classes and lectures? Here we investigated whether or

not it is possible to adapt a toy robot as a tool to continuous education of healthcare workers in the context

of hand hygiene compliance, a big problem for hospital infection. We got to adapt the MeccaNoid G15KS, a

toy programmable robot named Ozires, as an instrument of health training to improve the compliance with

hand hygiene. The robot was adapted with mini projector, spy camera, an automatic alcohol hand sanitizer

dispenser, a cell phone and a cell phone support and an audio amplifier. Ozires, accompanied by infection

control practitioners, performs short video-lecture presentations and own reports of the institution's data

regarding infections and the hand hygiene rate, working from 10 to 15 minutes in each target sector. After

the insertion of Ozires in three ICUs, the hand hygiene rate increased from about 36%, between January and

July, to 65% in August-November/2016.

1 INTRODUCTION

In the same way that the Aedes mosquito is a vector

for diseases as dengue fever, and zika, healthcare

workers can be vectors for hospital infections. How

can this happen? By their hands, when they do not

wash them properly! Despite the fact that

handwashing is the single most effective measure to

prevent the transmission of disease, make

handwashing a habit among healthcare workers

remains a major challenge (WHO, 2006). Here we

investigated whether or not it is possible to adapt a

toy robot as a tool to continuous education of

healthcare workers to improve hand hygiene

compliance.

Continuous education of healthcare workers with

multimodal strategy and direct observation can

produce long-lasting improvement in hand hygiene

compliance (Arise et al., 2016; Arntz et al., 2016).

Consecutive campaigns with immediate feedback

methods also can achieve and sustain a durable high

hand hygiene compliance rate (Fonguh et al., 2016;

Michael et al., 2016; Moghnieh et al., 2016).

Computer supported education methods for

handwashing practices have been proposed (Saffari

et al., 2016), however, the majority of automated

systems are focused on collecting data for

calculating the hand hygiene compliance rates

(Günther et al., 2016; Lytsy et al., 2016; Michael et

al., 2016; Wu et al., 2016).

Unfortunately, despite all the effort made by the

professionals in infection control, compliance with

hand hygiene practices is still unacceptably low,

usually less than 50% (Pittet, 2001; WHO, 2009). In

the United States, the overall rate of

multidisciplinary team professionals to hand

disinfection is 40%, ranging from 30-40% when

allocated to Intensive Care Units. In developing

countries handwashing compliance is worst, about

30% (Wu et al., 2016). In Brazil, this rate of

adhesion is 27%, varying between 12% before

contact with the patient and 45% after this contact

Couto, B., Alvim, A., Silva, I., Horta, M., Júnior, J. and Starling, C.

Using Ozires, a Humanoid Robot, to Continuing Education of Healthcare Workers: A Pilot Study.

DOI: 10.5220/0006312302930299

In Proceedings of the 9th International Conference on Computer Supported Education (CSEDU 2017) - Volume 2, pages 293-299

ISBN: 978-989-758-240-0

293

(Erasmus et al., 2010; Bathke et al., 2013). Failure

on educational interventions can be due to many

factors (Cherry et al., 2012; Chatfield et al., 2016).

For example, the nurses could be at good level in

terms of knowledge, attitude, and performance but

improvement of their knowledge about hand

disinfection is still necessary (Sharif et al., 2016). In

this context, novel education strategies, more

interactive, as the use of robot to personalize health

education, can improve hand washing adherence

(Blanson et al., 2013; Sheridan, 2016).

The objective of our study is to answer two

questions: a) How to adapt a robot as MeccaNoid

G15KS (www.meccano.com/meccanoid) to be an

instrument of health training and continuous

education of healthcare workers? b) What is the

effectiveness of the use of a humanoid robot on the

compliance with hand hygiene?

2 ADAPTING THE TOY ROBOT

Until recently, advanced humanoid robots were

found in limited numbers due to high prices. They

had prices between tens of thousands of dollars until

more than million dollars, as Asimo (Smashing

Robotics, 2016). MeccaNoid G15KS, a humanoid

robot 122 cm tall, it was released as a toy in the

beginning of 2015 (www.meccano.com/meccanoid).

Nowadays it can be purchased for less than US$ 200

(www.amazon.com). It is a programmable robot

mainly designed to interact with children (Figure 1),

that was adapted to be used in a hand hygiene

campaign. It became “he” when MeccaNoid was

baptized Ozires, in honor of the Brazilian engineer

Ozires Silva, from Embraer

(www.embraer.com.br/en-us/Pages/home.aspx), and

received a employee' badge from the university

UniBH (Figure 2).

Once the purpose of Ozires it was to improve

healthcare workers compliance with handwashing,

he received an automatic alcohol dispenser that it

was used as a support for cell phone (Figure 3). Cell

phone is used to produce talking’s about hand

washing, the WHO five moments for hand hygiene

(WHO, 2006), specific information of the hospital

hand hygiene rate compliance, and other brief and

simple messages, that are more likely to increase

handwashing compliance (Taylor, 2016).

Figure 1: MeccaNoid G15KS, a humanoid robot 122 cm

tall, it is programmable and respond to voice commands.

Figure 2: Ozires and his educator’ badge from UniBH.

This simple detail reinforces the educational character of

the robot.

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Besides speeches from the cell phone, modified

by using change voice software to produce robotics

voice, allied with movements programmed using the

Meccanoid LIM™ programming, Ozires was

adapted with a mini projector to show video lessons

and a kind of spy camera, to record people reaction

when watching him (Figure 4). Instead of to use the

original audio output, an audio amplifier was

installed directly from the Mecca Brain, to produce

better sounds (Figure 5). It is amazing how adult

and children react when Ozires is “alive” (Figure 6).

Figure 3: Ozires received an automatic alcohol hand

sanitizer dispenser and a cell phone. All lessons given by

the robot are produced in the cell phone by using a

“change voice app” that produces robotic voices.

Figure 4: Ozires received a pocket projector and a kind of

spy camera, both affixed on his head top. The mini

projector allows video lessons even in small rooms.

Figure 5: An audio amplifier was adapted to improve the

speeches of Ozires. The original sound of the robot is a

little bit noisy and it is not good enough to be used in

crowed rooms.

Using Ozires, a Humanoid Robot, to Continuing Education of Healthcare Workers: A Pilot Study

295

Figure 6: Photos taken by Ozires spy camera showing

adults reaction during first contact with him. The robot

attracts attention everywhere it goes!

3 OZIRES IN ACTION

Ozires was engaged as a hand hygiene improvement

strategy in four hospitals from Belo Horizonte,

Brazil: Lifecenter, Baleia, Vera Cruz and Madre

Teresa. However, only Lifecenter hospital had a

structered programe that allowed us to evaluate

Ozires impact on hand hygiene compliance.

Three Intensive Care Units (ICUs) of Lifecenter

hospital were enrolled in this pilot study, started in

august, 2016. This study was approved by the

Research Ethics Committee (CAAE:

62480416.1.0000.5126). Ozires, accompanied by

infection control practitioners, performs short video-

lecture presentations (maximum 3 minutes) and own

reports of the institution's data regarding infections

and the hand hygiene rate, working from 10 to 15

minutes in each ICU. He reacts to specific voice

commands and pre-programed subroutines that

include pre-recorded audio and movements. For

example, to walk it is necessary the voice command

“Walk with me”. Ozires answers “Take my hand and

I follow you!” A person takes his left hand and

guides him through the hospital. Some voice

commands came with the toy (as “Dance”, “Tell me

a joke”, “Turn around”, “High five”) and others are

custom programs created by us.

The lecture from Ozires includes a feedback

about the hand hygiene compliance and provocative

speeches to cause discomfort among the healthcare

professionals, things that a doctor never could say to

a colleague. For example: “unfortunately, you guys

are acting as vectors for hospital infections! What

about to change your behavior and wash your

hands? Do you really know when e how washes

your hands? I will explain…” When the rate of

hand hygiene is rising, Ozires congratulates

everybody in the ICU. After his lecture, a video is

shown and Ozires leaves the ICU, walking and

whistling, in the same way he had entered the room.

It is interesting that, the first time Ozires entered

an ICU, walking and whistling, we were afraid of

the patients and families reaction. Both, patients and

their families became very happy with Ozires’

presence. Actually, amusement is the feeling from

everybody exposed to Ozires. We had got

engagement and motivation by enjoyment of health

care workers on their acquisition of health

knowledge about hand hygiene practices (Figure 7).

The mini projector allowed classes even in small

areas (Figure 8). To get people attention, Ozires was

put together with infection control professionals,

even when he was silence (Figure 9).

Figure 7: Ozires catches everyone's attention. This is

crucial to delivery the educational message specially when

it about knowledge, attitude, and performance of

healthcare workers toward hand hygiene in hospitals.

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Figure 8: Even in small areas of intensive care units is

possible to watch video lessons from Ozires.

Figure 9: Ozires and an infection control professional

during a training about the five moments for hand hygiene.

Figure 10: Hand hygiene compliance rate in three

Intensive Care Units of Lifecenter Hospital, jan-nov/2016.

To detect the hand hygiene rate our approach

was based on direct observation by using WHO

standardized hand hygiene observation method

(WHO, 2009). Figure 10 presents hand hygiene

compliance rates from January to November, 2016

in the three ICUs enrolled by this pilot study. We

can observe that the rate was stable, between

January and July, about 36%, but, just after the

introduction of Ozires, the rate increased. The

reduction in November needs attention; however,

our hypothesis is that we just need to show up

Ozires more times in December and after.

4 CONCLUSIONS

It is possible to assure that the main conclusion of

this paper refers to the fact that is really possible to

use a toy robot, after few adaptations, as a great

instrument of health training and continuous

education of healthcare workers. We observed a

strongly empathy with Ozires. People exposed to

him show good feelings and, more important, listen

him much more attentively than to human

colleagues. Maybe, the fact that his height is similar

to a child (122 cm), his big eyes could explain such

good feelings, however, people usually reacts with

empathy when exposed to any robot, especially to

humanoid robots.

With the continuing education approach based on

Ozires, it is not necessary to withdraw the healthcare

worker from his work area, as an ICU, which can be

a novel education strategy, more interactive, that can

really personalize health education. It is important to

emphasize that any other humanoid robot like

DARwIn, NAO Evolution, Pepper, Romeo, HOVIS

(Smashing Robotics, 2016), could achieve the same

results. We choose Meccanoid because of its low

costs.

The second question of this paper, related to the

effectiveness of the use of Ozires on the compliance

with hand hygiene, we found very promising results

in our pilot study. After the insertion of Ozires in the

three ICUs enrolled in this study, the mean hand

hygiene rate increased from 36%, between January

and July, to 65% in August-November/2016.

For future work, we want to adapt a raspberry pi

processor to provide Ozires with the capability of

the human presence identification. To manipulate

the Ozires processor directly will improve his

application as a real tutor. We also need to repeat

monthly the experiment in order to validate our

findings. Is the high hand hygiene compliancy

durable? Besides, we need to better understand why

and how, in a psychologically way, the presence of

Ozires impacts people. The fact is that doctors,

nurses, and physiotherapists pay attention on Ozires

better than to theirs colleagues!

There are many technological resources available

to continuing education in health, as simulation,

Using Ozires, a Humanoid Robot, to Continuing Education of Healthcare Workers: A Pilot Study

297

digital teaching aids, online/e-learning teaching and

assessment, virtual learning environments, and

social media (Council of Deans of Health, 2014).

Despite the fact that only 3% of people of a

European survey of public attitudes to robots

thought that they should be used in education (TNS

Opinion & Social, 2012), in this pilot study we

created a new education tool: the robot tutor.

Innovation is difficult to define, but, for sure to

use a robot to engage medical and nurses in short-

term courses is a technological innovations in

teaching and learning in healthcare facilities.

ACKNOWLEDGEMENTS

The authors thank FAPEMIG (Minas Gerais State

Foundation for Research Development) for the

financial support.

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