7.4 Credentia NNAAP Skills, Part 1: Hand Hygiene, PPE, Personal Care, and Feeding

7.4 Credentia NNAAP Skills, Part 1: Hand Hygiene, PPE, Personal Care, and Feeding

If your training program tests with Credentia, your skills evaluation comes from the NNAAP skills list in Credentia's Alabama candidate handbook. The handbook lists 23 skills; Skill 12 (electronic blood pressure) is marked not tested in Alabama, so Alabama candidates can draw from the other 22, including the state-specific manual blood pressure skill. This section covers the hygiene, infection control, personal care, and feeding skills. Section 7.5 covers the measurement, mobility, and range of motion skills.

Steps That Appear in Almost Every NNAAP Skill

Credentia's step lists repeat the same opening and closing steps, and evaluators count them:

• Explain the procedure, speaking clearly, slowly, and directly, and maintaining face-to-face contact whenever possible. (Address the client by name and introduce yourself at the start of the Hand Hygiene skill; you do not need to reintroduce yourself for each later skill.)
• Provide privacy with a curtain, screen, or door.
• Signaling device within reach and bed in low position at the end.
• Wash your hands at the end (after the first hand washing, the evaluator will ask you to just say when you would wash).
• Remove and dispose of gloves without contaminating yourself, and avoid contact between your clothing and used linen.

Steps in bold in the handbook are Critical Element Steps; missing or botching one fails the skill. The critical steps are marked "(critical)" below.

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Skill 1: Hand Hygiene (Hand Washing)

Every Credentia candidate performs this skill first.

1. Address the client by name and introduce yourself.
2. Turn on the water, wet your hands and wrists thoroughly, and apply soap.
3. Lather all surfaces of the wrists, hands, and fingers with friction for at least 20 seconds, keeping hands lower than the elbows and fingertips down. (critical)
4. Clean fingernails by rubbing the fingertips against the palm of the opposite hand.
5. Rinse all surfaces of the wrists, hands, and fingers, keeping hands lower than the elbows and fingertips down. (critical)
6. Dry from the fingertips toward the wrists with clean, dry paper towels and discard them.
7. Turn off the faucet with a clean, dry paper towel (or a knee or foot control) and discard it.
8. Never touch the inside of the sink.

Skill 8: Donning and Removing PPE (Gown and Gloves)

1. Unfold the gown, face the back opening, and put your arms through the sleeves.
2. Fasten the neck, then secure the waist so the back of your clothing is covered as much as possible.
3. Put on gloves so the glove cuffs overlap the gown cuffs.
4. Before removing the gown, grasp one glove at the palm with the other gloved hand and remove it. (critical)
5. Slip the fingers of the ungloved hand under the cuff of the remaining glove at the wrist and remove it, turning it inside out. (critical)
6. Discard the gloves without contaminating yourself.
7. After removing the gloves, unfasten the gown at the waist and neck and remove it without touching the outside, holding it away from your body and off the floor, turning it inward so it ends inside out.
8. Discard the gown and wash your hands.

Note the order: on this skill the gloves come off before the gown, which matches the CDC sequence in Section 3.1.

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Skill 11: Gives Modified Bed Bath (Face and One Arm, Hand and Underarm)

1. Explain, provide privacy, and remove the client's gown into the soiled linen container while keeping the chest and lower body covered.
2. Check the water temperature for safety and comfort, and ask the client to confirm it is comfortable. Put on clean gloves.
3. Beginning with the eyes, wash the eyes with a wet washcloth (no soap), using a different area of the cloth for each stroke and washing from the inner to the outer aspect, then wash the face. (critical)
4. Dry the face. Expose one arm and place a towel under it.
5. With a soapy washcloth, wash the fingers (including fingernails), hand, arm, and underarm, keeping the rest of the body covered; rinse and dry them.
6. Move the client's body gently, put a clean gown on, and empty, rinse, and dry the basin before placing it in the dirty supply area.

Skill 21: Provides Perineal Care (Peri-Care) for Female

1. Explain, provide privacy, check water temperature, and ask the client to confirm comfort. Put on gloves and place a pad under the perineal area and buttocks.
2. Expose only the area between the hips and knees.
3. Wash the genital area from front to back, using a clean area of the washcloth for each stroke. (critical)
4. With a clean washcloth, rinse from front to back, using a clean area for each stroke. (critical)
5. Dry the genital area front to back.
6. Turn the client to the side and wash, rinse, and dry the rectal area front to back with a clean area for each stroke.
7. Reposition the client, clean up the basin and linen, and remove gloves properly.

Skill 18: Provides Catheter Care for Female

1. Explain, provide privacy, check water temperature with the client, put on gloves, and place a linen protector under the perineal area and buttocks.
2. Expose only the area around the catheter, between the hip and knee.
3. While holding the catheter at the meatus without tugging, clean at least 4 inches of the catheter, moving in only one direction away from the meatus, with a clean area of the washcloth for each stroke. (critical)
4. While holding the catheter at the meatus without tugging, rinse at least 4 inches the same way with a clean washcloth. (critical)
5. Dry at least 4 inches of the catheter, moving away from the meatus.

Skill 20: Provides Mouth Care and Skill 5: Cleans Upper or Lower Denture

• Mouth care: sit the client upright at 75 to 90 degrees, put on gloves, place a towel across the chest, moisten the toothbrush and apply toothpaste, and clean the mouth, including the tongue and all surfaces of the teeth, with gentle motions (critical). Hold the emesis basin to the chin while the client rinses, wipe the mouth, and clean up.
• Denture: put on gloves, line the sink or partly fill it with water before holding the denture over it, rinse the denture in moderate-temperature running water, brush all surfaces with denture toothpaste, rinse again, rinse the denture cup and lid, and store the denture in the cup with moderate-temperature water or solution with the lid on. Keep the toothbrush and denture clean throughout and drain or remove the sink liner.

Skill 19: Provides Foot Care on One Foot

Check the water temperature with the client, place the basin on a protective barrier, put on gloves, put the bare foot in the water, then wash, rinse, and dry it including between the toes. Apply lotion to the top and bottom of the foot, not between the toes, and remove the excess. Support the foot and ankle throughout.

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Skill 9: Dresses Client with Affected (Weak) Right Arm

1. Ask which shirt the client would like and use it. Keep the chest covered.
2. Remove the gown from the left (unaffected) side first, then from the right (weak) side, and place it in the soiled linen container.
3. Put the right (weak) arm through the right sleeve before putting the shirt on the left arm. (critical)
4. Move the body gently, without force, and finish with the clothing in place.

Skill 10: Feeds Client Who Cannot Feed Self

1. Look at the name card on the tray and ask the client to state their name.
2. Before feeding, make sure the client is sitting upright at 75 to 90 degrees. (critical)
3. Place the tray where the client can see it, clean the client's hands, and sit facing the client.
4. Tell the client what is on the tray and ask what they want first; offer one bite of each food, saying what it is, and offer the beverage at least once.
5. Ask whether the client is ready for each bite, clean the mouth and hands at the end, remove the tray, and leave the client upright with the call light in reach.

Skill 4: Assists With Use of Bedpan

Lower the head of the bed and put on gloves before placing the bedpan; after positioning the client, remove gloves, wash hands, and raise the head of the bed; leave toilet tissue, a hand wipe, and the call light within reach. Put on clean gloves and lower the head of the bed before removing the pan, keep the client covered, empty and rinse the pan into the toilet, and store it in the dirty supply area (Section 4.4).