7.2 Hand Hygiene Skill and When to Wash
Key Takeaways
- Skill 1 — Hand Hygiene is always one of the five Colorado Credentia skills. You must actually wash for this skill.
- Critical element: lather all surfaces of wrists, hands, and fingers producing friction for at least 20 seconds, hands lower than elbows, fingertips down.
- Critical element: rinse all surfaces of wrists, hands, and fingers the same way — hands lower than elbows, fingertips down.
- Dry from the fingertips with a clean dry paper towel. Use a new clean dry paper towel to turn off the faucet, or use a knee/foot control. Never touch the inside of the sink.
- After the assigned Hand Hygiene skill you may say “Now I would wash my hands” between later skills. You must still actually wash before recording a measurement. Soap and water — not alcohol — for visible soil, toileting/peri/catheter care, and C. difficile.
7.2 Hand Hygiene Skill and When to Wash
Quick Answer: On the Colorado Credentia Skills Evaluation, Skill 1 — Hand Hygiene (Hand Washing) is always assigned. You must actually wash. Two steps are critical elements (bold in the handbook): lather all surfaces of wrists, hands, and fingers producing friction for at least 20 seconds, hands lower than the elbows, fingertips down, then rinse those same surfaces the same way. Dry from the fingertips with a clean dry paper towel. Use a new clean dry paper towel to turn off the faucet (or a knee/foot control). Never touch the inside of the sink. After this skill you may say "Now I would wash my hands" between later skills. You still wash before recording a measurement. Use soap and water, not alcohol, for visible soil, after toileting, peri care, or catheter care, and for C. difficile.
Why Skill 1 is always first
The Colorado handbook lists 23 skills. Hand Hygiene is listed first on purpose, not in alphabetical order, as a reminder to wash before the other skills. The evaluator always puts it on your five-skill card. You have 30 minutes for all five skills and a five-minute warning at 25 minutes. Fail Skill 1 — miss a critical element, or miss too many remaining steps — and you fail the Skills Evaluation, because you must pass five of five.
The opening of Skill 1 is the same opening as almost every other skill: address the client by name and introduce yourself by name. Then you go to the sink. After you have introduced yourself once, you do not have to introduce yourself again at the start of each later skill.
Skill 1 — handbook steps in order
Memorize the official sequence. Bold steps are critical elements. Miss either one and the skill fails even if everything else is pretty.
| Step | What Credentia Colorado requires |
|---|---|
| 1 | Address the client by name and introduce yourself by name |
| 2 | Turn on the water at the sink |
| 3 | Wet hands and wrists thoroughly |
| 4 | Apply soap to hands |
| 5 CE | Lather all surfaces of wrists, hands, and fingers producing friction for at least 20 seconds, hands lower than the elbows, fingertips down |
| 6 | Clean fingernails by rubbing fingertips against the palms of the opposite hand |
| 7 CE | Rinse all surfaces of wrists, hands, and fingers, hands lower than the elbows, fingertips down |
| 8 | Dry from the fingertips toward the wrists with a clean dry paper towel, then dispose of it |
| 9 | Use a new clean dry paper towel to turn off the faucet, then dispose of it — or use a knee/foot control |
| 10 | Do not touch the inside of the sink at any time |
Hands stay lower than the elbows and fingertips point down so dirty water runs off the fingers, not up the clean forearms. Friction is the work. Wetting and rinsing without 20 seconds of lather is not washing. "All surfaces" means palms, backs, wrists, between fingers, thumbs, and fingertips — not a two-second palm rub.
Dry starting at the fingertips. A towel that wiped the faucet is dirty; that is why step 9 requires a new towel (or a foot/knee control). Touching the inside of the sink — even "just to steady yourself" — is a listed fail.
You must use running water. Telling the evaluator you would wash is not enough for Skill 1 itself.
When to wash versus an alcohol rub
Alcohol-based hand rub is fine for routine moments when hands are not visibly soiled and the organism is not a spore-former: entering a room, after taking a pulse, before gloves on a clean task. Rub until dry.
Soap and water is required when:
- Hands have visible soil, blood, or body fluid.
- You have just done toileting, peri care, or catheter care — those tasks load hands with gut and genital organisms that need friction and rinse.
- The client has C. difficile. Alcohol does not kill spores. Only soap, friction, and rinse physically remove them.
- You have used the restroom or are about to eat.
Wash or rub before putting gloves on and immediately after taking them off. Gloves tear. Hands become dirty during removal. Gloves are not a substitute for clean hands.
Skills-test rule: “Now I would wash my hands”
The Colorado Skill Evaluation page is specific. After you have performed the assigned Hand Hygiene skill, you do not have to rewash at the sink after every later skill. You say to the evaluator, "Now I would wash my hands," at the moment you would wash in a real room. That spoken line gets credit for the handwash step on later skills.
Two limits:
- You must actually wash for Skill 1. You cannot describe Skill 1.
- For every step other than handwashing, you must perform the step. You cannot say "I would lock the wheelchair" or "I would put on gloves." Do the step.
Always wash before recording a measurement. Credentia measurement skills — radial pulse, respirations, electronic blood pressure, manual blood pressure, urinary output, and ambulatory weight — all require hand hygiene before you write the number. Do not touch the recording sheet or the digital Candidate Results box with dirty hands. If a measurement skill is later on your card, either wash at the sink or clearly say the line before you record, following the evaluator's station rules. The handbook's own wording on those skills is "Before recording, washes hands."
When the whole evaluation is over, the evaluator will tell you to wash your hands as a hygiene measure. That last wash does not change your score, but you still do it.
Colorado scenario
You are at a Credentia skills site in Colorado Springs. Your card lists Hand Hygiene, PPE, female peri care, radial pulse, and a transfer. You introduce yourself to the candidate volunteer, wash with 20 seconds of friction, fingertips down, rinse the same way, dry from the fingertips, and turn the faucet with a new paper towel. You never touch the sink bowl.
After peri care you look at the evaluator and say, "Now I would wash my hands." You do not skip putting the call light in reach, and you do not describe glove removal — you perform those steps. Before you record the radial pulse, you wash or say the line again so the number is written with clean hands. A classmate later says, "I just told them I would wash for Skill 1 so I could save time." That classmate failed the always-assigned skill. The spoken line is only for later skills, after a real wash.
On the floor that afternoon you empty Mr. Diaz's commode. He is on contact precautions for C. difficile. Alcohol foam is on the wall. You still walk to the sink. Spores survive alcohol. Soap, 20 seconds of friction, rinse, new towel on the faucet.
Exam traps
- Lathering 10 seconds, or keeping hands higher than the elbows so rinse water runs toward the uniform.
- Drying from the wrists toward the fingertips, or turning the faucet with the same wet towel — or with bare clean fingers.
- Touching the inside of the sink.
- Using alcohol after C. difficile, visible soil, peri care, or catheter care.
- Describing Skill 1 instead of washing, or describing other steps instead of doing them.
- Recording a pulse, blood pressure, weight, or output with dirty hands.
- Thinking gloves replace hand hygiene.
Which action is a Credentia Colorado critical element for Skill 1 Hand Hygiene?
A Pueblo resident is on contact precautions for C. difficile. After removing gloves, which hand hygiene method is required?
On the Colorado skills evaluation, after you have already performed the assigned Hand Hygiene skill, what may you do between later skills?