Handwashing, PPE, and Critical Steps
Key Takeaways
- Hand hygiene is the most important infection-control skill and is often a scored skill or required between care steps on Prometric exams.
- Standard handwash: wet hands, apply soap, scrub all surfaces at least 20 seconds, rinse, dry with clean towel, use towel to turn off faucet.
- PPE order for isolation: gown, mask, goggles/face shield, gloves — removal is reversed to prevent contamination.
- Don and remove gloves without touching contaminated outer surfaces; perform hand hygiene before and after glove use.
- Critical failures include skipping handwashing, improper glove removal, and reusing single-use PPE.
Handwashing, PPE, and Critical Steps
Quick Answer: Infection control wins or loses skills exams. Handwashing with all surfaces scrubbed ~20 seconds, correct PPE don/doff, and hand hygiene before and after gloves are critical steps Prometric evaluators watch closely.
Medical Asepsis vs Surgical Asepsis
CNAs primarily practice medical asepsis (clean technique) to reduce pathogen spread. Surgical asepsis (sterile technique) is generally beyond CNA scope except following specific trained tasks.
Hand Hygiene Steps (Skills Exam)
Prometric handwashing skill typically requires:
- Introduce self; verify resident if at sink in room.
- Turn on water; adjust temperature comfortably warm.
- Wet hands and wrists.
- Apply soap.
- Lather 20 seconds minimum — palms, backs, between fingers, thumbs, fingertips, wrists.
- Rinse soap downward.
- Dry with clean paper towel from fingertips to wrists.
- Use dry towel to turn off faucet (or foot pedal if present).
- Discard towel; no recontamination of hands.
Alcohol-based sanitizer is acceptable only when hands not visibly soiled and policy allows — skills exam usually tests soap and water.
When Hand Hygiene Is Required
- Before and after resident contact
- Before donning and after removing gloves
- After contact with bodily fluids
- After touching equipment in room
- Between dirty and clean tasks during peri-care
Skipping handwash between gloves off and next task is a critical fail.
Personal Protective Equipment (PPE)
For contact precautions example sequence:
Donning: gown → mask/respirator if ordered → goggles/face shield → gloves (cuffs over gown).
Removing: gloves first (inside-out) → hand hygiene → goggles → gown (roll inside out) → mask → hand hygiene.
Removing contaminated PPE in wrong order contaminates skin and clothing — tested on written and skills exams.
Glove Use
- Select correct size.
- Inspect for tears.
- Don without touching outer surface excessively.
- Change between dirty and clean procedures.
- Remove by peeling inside-out; dispose; handwash.
Never wash and reuse disposable gloves.
Other High-Yield Critical Steps
Across skills, evaluators commonly mark critical:
- Two identifiers for resident (name, DOB per facility)
- Privacy — close curtain, knock
- Call light within reach before leaving
- Bed lowest position and wheels locked after care
- Side rails only per policy (not automatic restraints)
Worked Scenario: Peri-Care Sequence
Trap: don gloves → peri-care → remove gloves → leave room.
Correct: handwash → explain → gloves → clean front to back → remove gloves → handwash → reposition → call light → handwash if needed.
Bloodborne Pathogen Reminder
Treat all blood/body fluids as infectious. Wear gloves; report exposure to supervisor immediately per OSHA post-exposure policy.
Exam Traps
- Hand sanitizer replaces visible soil handwash — wrong on skills test
- Gloves replace handwashing — false
- Gown after gloves on donning — wrong order
Alcohol-Based Hand Rub vs Soap
WHO moments for hand hygiene apply in facilities. Skills exam emphasizes soap and water when hands visibly soiled or after C. diff exposure per policy.
C. difficile Precautions
Soap and water preferred; gloves and gowns; dedicated equipment when possible — exams test contact precaution knowledge.
Respiratory Hygiene
Cover cough; tissues; hand hygiene; mask if ordered during respiratory illness outbreaks.
Sharps Safety
Never recap needles if prohibited; report needlestick immediately; follow OSHA exposure plan.
Linen Handling
Hold soiled linen away from body; bag without shaking; handwash after.
Environmental Cleaning
Clean high-touch surfaces per policy; separate clean and dirty supplies.
Indirect Care Checklist Printable
Introduce → identify → explain → privacy → gather supplies → wash hands → procedure → comfort → call light → wash hands → document.
Common Skills Failures Nationwide
Forgot call light; no handwash between gloves off and leaving room; wrong resident identification; bed left high.
Scenario: Isolation Room Exit
Remove PPE in anteroom if present; discard in designated containers; handwash before entering clean corridor.
Blood Exposure
Stop care; remove gloves; wash; report to supervisor; document per post-exposure protocol.
Exam Written Tie-In
Know PPE order, handwash duration, glove doffing — high-yield items.
Fingernail and Jewelry Standards
Short natural nails; no artificial nails in many facilities; minimal jewelry — exam site rules mirror clinical standards.
Sink Splash Contamination
Stand back slightly; avoid touching sink basin after wash.
Glove Size and Tears
Change gloves if torn; never continue with hole.
Isolation Signage
Read door card before entry; gather all supplies to minimize trips.
N95 Fit Testing Note
Some facilities fit-test for TB or outbreak; CNAs follow respiratory protection program if enrolled — beyond basic CNA but written exams may mention wearing ordered mask.
Indirect Care Verbal Script Example
"Good morning, Mrs. Lee, I'm Alex, your nurse aide. I'm going to help you wash your hands before lunch. Is that okay? I'll close the curtain for privacy."
Skills Exam Timing
Work steadily — rushing causes skipped critical steps; evaluator prefers safe pace with narration.
Warm Water Temperature
Comfortable warm — not scalding; test on inner wrist if assisting resident handwash.
Jewelry and Artificial Nails (CMS Guidance)
Many surveys cite artificial nails as infection risk — exam may reference short natural nails policy.
Double Bagging Linen
If heavily soiled, bag inside room per policy before transport.
Eye Protection Splash Risk
Wear goggles if splash risk during peri-care or suctioning per training.
Hepatitis B Vaccine Offer
OSHA requires employer offer to at-risk staff — know your rights separately from exam.
Skill-Specific PPE
Gloves for body fluid contact; gown if soiling expected; mask if splash to face possible.
Practice Counting 20 Seconds
Hum "Happy Birthday" twice or count silently — muscle memory for test day.
Evaluator Eye Contact
They watch towel disposal and faucet shutoff — complete sequence every time.
During the Prometric handwashing skill, when should the candidate use a paper towel to turn off the faucet?
What is the correct order for donning PPE when gown, mask, eye protection, and gloves are all required?
After removing contaminated gloves following peri-care, the CNA should: