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.
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
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
Copyright © 2017 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
(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 ( 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?
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 (
Nowadays it can be purchased for less than US$ 200
( 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
(, 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.
CSEDU 2017 - 9th International Conference on Computer Supported Education
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
Figure 6: Photos taken by Ozires spy camera showing
adults reaction during first contact with him. The robot
attracts attention everywhere it goes!
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.
CSEDU 2017 - 9th International Conference on Computer Supported Education
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.
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
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
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.
The authors thank FAPEMIG (Minas Gerais State
Foundation for Research Development) for the
financial support.
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Using Ozires, a Humanoid Robot, to Continuing Education of Healthcare Workers: A Pilot Study