7.2 Hand Hygiene and PPE

Hand Hygiene and PPE

Quick Answer: Use alcohol-based hand rub (ABHR) for routine decontamination of visibly clean hands — rub until dry, about 20 seconds. Use soap and water when hands are visibly soiled, after using the restroom, before eating, and — most importantly — for suspected or confirmed C. diff (spores resist alcohol). The 5 Moments of Hand Hygiene tell you when. Don PPE in this order: gown → mask → goggles → gloves. Doff in this order: gloves → goggles → gown → mask.

Hand hygiene is THE single most effective infection-control action you perform, and it is a critical (bolded) step on the Indiana clinical skills evaluation. Missing it fails the skill outright.

Soap and Water vs. Alcohol-Based Hand Rub

The C. Diff Exception (Trap — Test Favorite)

Trap: For suspected or confirmed Clostridioides difficile (C. diff), use soap and water — NOT ABHR. C. diff produces spores that alcohol cannot kill; ABHR reduces vegetative cells but leaves spores on the hands. Soap and water physically washes spores off the skin. This is one of the most-tested infection-control facts on the Indiana CNA exam.

C. diff causes severe diarrhea in residents on antibiotics — the elderly LTC resident on broad-spectrum antibiotics is the classic susceptible host. If you care for a C. diff resident, wash with soap and water for at least 20 seconds (the full skills-eval technique), then dry with paper towels. Use a sporicidal disinfectant (usually bleach-based) on environmental surfaces.

The 5 Moments of Hand Hygiene (WHO)

The World Health Organization defines five moments when hand hygiene is mandatory:

1. Before touching a resident — protects the resident from your hands
2. Before a clean/aseptic task — protects the resident during procedures like catheter care, oral care, or observing a dressing change
3. After body fluid exposure risk — protects you and the environment from the resident's fluids (after perineal care, after emptying a drainage bag, after handling soiled linen)
4. After touching a resident — protects you and the environment
5. After touching the resident's surroundings — protects you even when you did not touch the resident (bedrails, call light, IV pump, bedside table, privacy curtain)

Trap: Do not reuse gloves between tasks or between residents. Gloves are single-use. Wearing the same pair of gloves from one resident to another, or from a soiled task to a clean task, is a direct violation of standard precautions and a critical-step failure on the skills evaluation. Change gloves, perform hand hygiene, then re-glove.

Donning and Doffing PPE

PPE selection depends on the task. The general principle: put on PPE before entering the resident's room (or before the task), and remove it at the doorway before leaving (with the exception of an N95 for airborne, which is removed outside the door).

Donning Order (put on)

Doffing Order (remove)

Trap: The order is not random — gloves come off FIRST because they are the most contaminated. The mask comes off LAST so you do not contaminate your face handling other items. Never touch the front of the mask or gown during removal — always use the ties.

PPE Selection by Task

The surgical mask protects the wearer from droplets; the N95 respirator filters airborne nuclei. The CNA does not fit-test the N95 — the facility does. If you have not been fit-tested for an N95, do not enter an airborne-precaution room; notify the nurse so a fit-tested staff member can provide care.

Hand Hygiene Technique (Skills Evaluation Critical Steps)

The Indiana clinical skills evaluation scores hand hygiene as a critical step within other skills. Full soap-and-water technique:

1. Wet hands with warm water
2. Apply soap
3. Rub palms, then backs of hands, between fingers, around thumbs, fingertips, and wrists for at least 20 seconds
4. Rinse thoroughly under running water, fingertips pointing DOWN so water runs off (not up the arms)
5. Dry with paper towels
6. Turn off faucet with a paper towel (do not recontaminate clean hands)

ABHR technique: apply enough product to cover all hand surfaces, rub the same way as soap until dry — minimum 20 seconds. Do not wipe off; let it air-dry.

Trap: For C. diff care, ABHR at the doorway is NOT enough — walk to the sink and use soap and water. Some Indiana facilities post a "WASH WITH SOAP AND WATER" sign on C. diff doors to override the ABHR dispenser — always follow the posted sign.