7.2 Core Workflows: Hand Hygiene, PPE, and Precautions

7.2 Core Workflows: Hand Hygiene, PPE, and Precautions

Handwashing procedure (skills-tested)

Proper handwashing is a graded STNA skill. Perform every step in order:

1. Turn on warm (not scalding) water and wet hands with fingertips pointing down.
2. Apply soap and lather, rubbing all surfaces — palms, backs, between fingers, around thumbs, under nails — for at least 20 seconds (about humming "Happy Birthday" twice).
3. Keep hands lower than elbows so water runs from clean to dirty.
4. Rinse from wrists to fingertips, then dry with a clean paper towel.
5. Use a dry paper towel to turn off the faucet so you do not recontaminate your hands, and to open the door if needed.

Graders watch for the details that ruin the skill: starting with hands pointing up (dirty water runs back onto clean fingers), scrubbing for less than the required time, touching the inside of the sink, or turning off the faucet with a bare clean hand. Each of these can cost you the station. Practice the full sequence until it is automatic, because hand hygiene is performed at the start and end of essentially every skill you might be assigned.

When to wash vs. when to use alcohol rub

Alcohol-based hand rub (ABHR), 60-95% alcohol, is the preferred routine method when hands are NOT visibly soiled. But soap and water are required in specific situations the exam loves:

Key hand-hygiene moments — sometimes called the "five moments" — are: before touching a resident, before a clean or aseptic task, after exposure to body fluids, after touching a resident, and after touching the resident's surroundings. Add to that: before donning and after removing gloves, before and after eating, and after using the restroom. When two answers both mention hand hygiene, the one that performs it at the correct moment (for instance, before a clean catheter-bag task rather than only at the end) is the better choice.

A practical note on skin care: ABHR is gentler and faster than repeated washing, which is one reason the CDC prefers it for routine, non-soiled hands. But the exam's hard rule stands — visible soil, spore-formers like C. diff, and norovirus all override the convenience of rub and demand soap and water.

Donning and doffing PPE

The order is sequence-critical and frequently tested. Don (put on): gown → mask/respirator → goggles or face shield → gloves (gloves go on last so they cover the gown cuffs). Doff (take off): gloves → goggles/face shield → gown → mask, then perform hand hygiene. Gloves come off first because they are the most contaminated; the mask comes off last because you remove it after leaving the room and away from your face.

Gloves are single-use: change them between residents and between a dirty task and a clean task on the same resident (for example, after perineal care before adjusting a pillow). Gloves never replace hand hygiene — wash or rub before and after. When you doff gloves, use the glove-in-glove technique: peel the first glove off by the cuff so it turns inside out, ball it in the still-gloved hand, then slide a bare finger under the second cuff and peel it over the first, trapping both inside. Never touch the outside of a soiled glove with bare skin.

Also match the gown and mask to the task. A gown is worn when clothing may be soiled by splashing or large amounts of fluid; a mask and eye protection are worn when splashes or sprays to the face are likely, such as during oral suctioning by licensed staff. The aide should remove PPE before leaving the resident's room (except the respirator, which comes off after leaving an airborne-isolation room) and perform hand hygiene immediately.

Transmission-Based Precautions

Added ON TOP of Standard Precautions when a specific organism requires it:

• Contact (MRSA, VRE, C. diff, scabies, draining wounds): gown and gloves; dedicate equipment to the room when possible.
• Droplet (influenza, pertussis, bacterial meningitis): surgical mask within ~6 feet; private room or cohorting.
• Airborne (tuberculosis, measles, varicella): N95 respirator and a negative-pressure (airborne infection isolation) room with the door closed.

Isolation and the resident's dignity

When a resident is on isolation, the aide still provides full care, explains why PPE is worn, and avoids making the resident feel "dirty" or punished. Bag soiled linens at the bedside, do not shake them, and follow the facility's biohazard disposal policy. Isolation residents are at higher risk of loneliness and depression, so the aide should spend time talking, answer the call light promptly, and never rush care. Visitors should be taught the same precautions before they enter.

These dignity-and-rights elements are testable: an answer that protects against germs but humiliates the resident is not the best answer, because resident rights and infection control must be balanced together.