Skills Checklist: Hand Hygiene & Personal Protective Equipment
Key Takeaways
- Hand Hygiene is assigned to every Rhode Island candidate on the Skills Evaluation — it is the one skill you know in advance you will perform.
- The critical element is lathering all surfaces of wrists, hands, and fingers with friction for at least 20 seconds, hands lower than the elbows with fingertips down.
- Never touch the inside of the sink at any time; use clean dry paper towels to dry and a separate paper towel to turn off the faucet.
- On the PPE skill, glove cuffs must overlap gown cuffs, and gloves come off before the gown, with the gown removed without touching its outside.
- You may verbalize handwashing between other skills, but the Hand Hygiene skill itself must be physically performed with running water.
Skills Checklist: Hand Hygiene & Personal Protective Equipment
Hand Hygiene is the single skill you can prepare for with certainty: it is always one of the five assigned in Rhode Island. It is also, unforgivingly, one of the most commonly failed, because candidates rush the timing and touch the sink.
Skill 1 — Hand Hygiene (Hand Washing)
Critical Element Steps are marked ★.
| # | Step |
|---|---|
| 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 | ★ Lather all surfaces of wrists, hands, and fingers producing friction, for at least 20 seconds, keeping hands lower than the elbows and the fingertips down |
| 6 | Clean fingernails by rubbing fingertips against the palms of the opposite hand |
| 7 | ★ Rinse all surfaces of wrists, hands, and fingers, keeping hands lower than the elbows and the fingertips down |
| 8 | Use clean, dry paper towel(s) to dry all surfaces of fingers, hands, and wrists starting at the fingertips, then dispose of the towel(s) into the waste container |
| 9 | Use clean, dry paper towel(s) to turn off the faucet, then dispose of them; or use a knee or foot control |
| 10 | ★ Do not touch the inside of the sink at any time |
Why each rule exists
- Twenty seconds with friction. Soap suspends organisms; friction and time are what actually remove them. Count it deliberately — a hummed "Happy Birthday" twice is the classic timer, and evaluators do count.
- Hands lower than elbows, fingertips down. Water carries contamination in the direction it flows. Fingertips are the dirtiest part of the hand and must drain into the sink, not run back up your forearms.
- Dry from fingertips toward wrists. Same logic in reverse — move from cleanest to least clean.
- A separate towel for the faucet. You turned that faucet on with dirty hands. Touching it with clean hands re-contaminates them.
- Never touch the inside of the sink. The sink basin is considered contaminated. Brushing it with a wrist or a sleeve fails the skill.
The most common failures
- Washing for 10–15 seconds and moving on.
- Holding hands level or elevated, letting water run toward the wrists.
- Turning off the faucet with a bare hand.
- Touching the sink basin while rinsing.
- Failing to introduce yourself by name at the start.
- Skipping the fingernail step.
💡 The verbalization rule. For skills other than Hand Hygiene, you may tell the evaluator, "Now I would wash my hands," as long as you say when. But when Hand Hygiene is the assigned skill, it must be physically performed with running water from start to finish.
Alcohol-Based Hand Rub — Know When It Is Not Enough
Alcohol-based hand rub containing 60% to 95% alcohol is the preferred method for routine hand hygiene in practice when hands are not visibly soiled. Cover all surfaces and rub until completely dry.
Soap and running water are required — hand rub will not do — when:
- Hands are visibly soiled with dirt, blood, or body fluids
- Before eating and after using the restroom
- After caring for a resident with C. difficile, norovirus, or another spore-forming organism, because alcohol does not kill spores
- At the beginning and end of your shift
Skill 8 — Donning and Removing PPE (Gown and Gloves)
| # | Step |
|---|---|
| 1 | Pick up the gown and unfold it |
| 2 | Facing the back opening of the gown, place arms through each sleeve |
| 3 | Fasten the neck opening |
| 4 | Secure the gown at the waist, ensuring the back of your clothing is covered as much as possible |
| 5 | Put on gloves |
| 6 | Verify the cuffs of the gloves overlap the cuffs of the gown |
| 7 | ★ Before removing the gown, with one gloved hand, grasp the other glove at the palm and remove it |
| 8 | ★ Slip the fingers of the ungloved hand underneath the cuff of the remaining glove at the wrist and remove it, turning it inside out as it is removed |
| 9 | Dispose of gloves into the designated waste container without contaminating yourself |
| 10 | After removing gloves, unfasten the gown at the waist and neck |
| 11 | After removing gloves, remove the gown without touching the outside of the gown |
| 12 | While removing the gown, hold it away from your body without touching the floor, turn it inward, and keep it inside out |
| 13 | Dispose of the gown in the designated container without contaminating yourself |
| 14 | After completing the skill, wash hands |
The logic to reconstruct under pressure
Dirty to clean, outside never touches skin. Gloves are the dirtiest thing on you, so they come off first. Glove-to-glove for the first, skin-to-skin under the cuff for the second — your bare fingers never touch the outside of a used glove. Then, with clean hands, unfasten the ties and peel the gown off by the inside, rolling the contaminated outer surface inward.
Errors that fail this skill
- Unfastening the gown before removing gloves. Your gloved hands touch the ties, then your clean hands touch them again.
- Grabbing the second glove from the outside instead of sliding fingers under the cuff.
- Touching the outside of the gown during removal.
- Letting the gown touch the floor or your uniform.
- Glove cuffs not overlapping the gown cuffs when donning.
- Not washing hands at the end.
⚠️ Glove errors are not correctable after a prompt. The Rhode Island correction rules state that if you do not put gloves on or take them off when required and the evaluator reminds you, you will not get credit for trying to correct that step. Every other correctable step gets a second chance; this one does not.
When Gloves Are Required
Any task involving actual or potential contact with blood, body fluids, secretions, excretions, mucous membranes, or non-intact skin — perineal care, catheter care, emptying a bedpan or urinal, mouth care, denture care, shaving, cleaning up spills, handling soiled linen, and any dressing contact.
Change gloves between residents, always, and between tasks on the same resident when moving from a dirty area to a clean one — for example after perineal care and before repositioning a pillow. Wash or sanitize hands after removing gloves every time: gloves have microscopic defects and hands become moist and contaminated inside them.
During the Hand Hygiene skill, at what point may the candidate touch the faucet handles with bare hands?
On the PPE skill, how is the second glove removed?
A nurse aide has just finished caring for a resident on Contact Precautions for C. difficile. Her hands are not visibly soiled. What hand hygiene is required?