5.2 Hand Hygiene: The #1 Infection Prevention Measure
Key Takeaways
- Handwashing is the #1 infection prevention measure and an INACE tested skill
- Proper technique requires at least 20 seconds of friction covering all hand surfaces
- Use a paper towel to turn off the faucet — this is a critical step on the skills test
- Keep hands pointed downward during rinsing so water flows from clean to dirty areas
- Alcohol-based hand sanitizer is NOT effective against C. diff and Norovirus — use soap and water
- Hand hygiene is required before/after every patient contact, after glove removal, and after body fluid exposure
Hand Hygiene: The #1 Infection Prevention Measure
Handwashing is the single most important action a CNA can take to prevent the spread of infection. It is also one of the 21 mandated performance skills on the INACE clinical evaluation and is a component of virtually every other skill you demonstrate. Proper hand hygiene technique is critical for passing the skills test.
When to Perform Hand Hygiene
The World Health Organization (WHO) "5 Moments for Hand Hygiene" guides healthcare workers:
| Moment | When | CNA Example |
|---|---|---|
| 1. Before Patient Contact | Before touching the resident | Before taking vital signs, before repositioning |
| 2. Before Aseptic Task | Before clean/sterile procedures | Before wound dressing change, before catheter care |
| 3. After Body Fluid Exposure | After contact with body fluids | After toileting, after changing a soiled brief |
| 4. After Patient Contact | After touching the resident | After bathing, after feeding |
| 5. After Touching Surroundings | After touching objects near the resident | After adjusting the bed, touching the call light |
Additional Times to Wash Hands
- At the beginning and end of each shift
- Before and after eating or handling food
- After using the restroom
- After coughing, sneezing, or blowing your nose
- After removing gloves (gloves are not a substitute for handwashing)
- Before and after each resident you care for
- After handling dirty linen or trash
Proper Handwashing Technique (INACE Tested Skill)
This is the exact technique you must demonstrate on the clinical skills evaluation:
Step-by-Step Procedure:
- Stand at the sink — Do not touch the sink with your body
- Turn on warm water — Adjust to comfortable temperature
- Wet hands and wrists — Hold hands lower than elbows so water flows from clean to dirty
- Apply soap — Use enough to create a good lather
- Rub hands vigorously for at least 20 seconds (sing "Happy Birthday" twice):
- Palm to palm
- Between fingers (interlace)
- Back of each hand
- Fingertips and nails (cup fingers in palm)
- Thumbs (grip and rotate)
- Wrists
- Rinse thoroughly — Hold hands lower than elbows, rinse from wrists to fingertips
- Dry with paper towel — Pat hands dry completely
- Turn off faucet — Use a clean paper towel to turn off the faucet (do not touch with clean hands)
- Dispose of paper towel — In the waste container without touching the container
Critical Steps for the Skills Test
On the INACE clinical evaluation, failure to perform these steps correctly can result in failing the handwashing skill:
| Critical Step | Why It Matters |
|---|---|
| 20-second minimum | Less time does not adequately remove microorganisms |
| Friction (rubbing) | Physical action dislodges organisms from skin |
| Between fingers | Common area where organisms hide |
| Fingertips and nails | Most contaminated area on hands |
| Rinse hands-down | Prevents contaminated water from running up the arms |
| Paper towel to turn off faucet | Faucet handles are contaminated from before washing |
Alcohol-Based Hand Rub (ABHR)
Alcohol-based hand sanitizer (at least 60% alcohol) is an acceptable alternative WHEN hands are not visibly soiled:
| Use ABHR When | Use Soap and Water When |
|---|---|
| Hands are not visibly dirty | Hands are visibly soiled or dirty |
| Between residents in rapid succession | Before eating or handling food |
| After touching clean surfaces | After using the restroom |
| When sink is not immediately available | After caring for a resident with C. diff or Norovirus |
| Before putting on gloves | After removing gloves that are visibly soiled |
Important: Alcohol-based hand rub is NOT effective against C. difficile spores and Norovirus. In these cases, soap and water is required.
ABHR Technique
- Apply a palmful of product to one hand
- Rub hands together covering all surfaces
- Continue rubbing until hands are completely dry (about 20 seconds)
- Do NOT wipe or rinse hands after applying
Common Handwashing Errors
| Error | Correction |
|---|---|
| Too brief | Must be at least 20 seconds of friction |
| Skipping between fingers | Interlace and rub between all fingers |
| Touching faucet after washing | Use paper towel to turn off faucet |
| Not drying completely | Wet hands transfer more organisms than dry |
| Hands higher than elbows during rinsing | Keep hands pointed downward |
| Using hand sanitizer for C. diff | Must use soap and water for C. diff |
How long should you rub your hands with soap during proper handwashing?
After washing your hands, how should you turn off the faucet?
A resident has been diagnosed with C. difficile (C. diff). Which hand hygiene method is required?