How long should a nursing assistant use friction when lathering and washing her hands?

An important skill for anyone in the medical profession is the prevention of disease transmission through an infection control system.  Infection control begins with proper hand washing.  Hand washing removes both visible dirt and invisible microorganisms that can cause disease.  In order to get the most benefits from hand washing, you should follow these steps.

1. Before you wash your hands, remove any jewelry on your hands or wrists, such as rings, watches, or bracelets.
2. Turn on the water and make sure it is comfortably warm, but not so hot it burns your hands.  Get your hands wet all the way up to your wrists.
3. Use a dime-sized amount of liquid or foam soap.
4. Begin to lather the soap for at least thirty seconds.  One tip- sing the “Happy Birthday Song” or “ABC song” twice to make sure you have washed for long enough.  Press hands firmly together as you wash – friction is an important factor as you wash.  Be sure to work soap under and around your fingernails, as this is a prime spot for germs to hide.
5. As you wash, be sure your hands are positioned downward, lower than your elbows, to keep microorganisms from travelling up the arm.  If your hands touch the inside surface of the sink, start the hand washing procedure again to ensure hands have not become contaminated.
6. If your hands have been in contact with bodily fluids such as blood, urine, mucus, or vomit, you need to spend at least one minute washing hands, even after visible dirt is gone.
7. Rinse hands under warm water, and then dry your hands with a clean towel.  Disposable towels are preferred since towels that are re-used may contain more germs.

As a nurse’s aide, there are numerous times throughout the day when you will be required to wash your hands.  Even if gloves are worn, you mush wash your hands before feeding a patient, before and after coming in contact with a patient’s wound, after touching soiled linens.  You will also need to wash your hands before performing any procedure on a patient, and before entering or leaving a patient’s room.  Your attention to detail when washing hands can mean safer, healthier environment for both you and your patients.

Examiner Checklist For This Skill

1)  Stood in such a way that the clothes did not touch the sink.

2)  Turned on the water and adjusted temperature to warm; left the water
running.

3)  Wet wrists and hands; At all times kept the level of hands lower than that of the elbow.

4) Applied soap or cleaning agent to hands using available products.

5)  Washed both hands and wrists using friction for at least 15-20 seconds.

6)  Rinsed both hands and wrists properly under running water with fingertips pointed down.

7)  Dried hands properly with paper towel(s) from fingertips to wrists.

8)  Disposed of all used paper towel(s).

9)  Used dry paper towel between hand and faucet to turn off water.

10)  Disposed of used paper towels.

Expert Tip by Tanya Glover, CNA

Having worked as a CNA for many years, I have a lot to say about the skill of hand washing. The main thing I have to say is that it is not done nearly enough! When we are in training to become CNAs, hand washing is something we pay very close attention to. When we do our clinicals we are still following the rules to a tee. However, once we get into a nursing home we begin to notice that the other workers do not wash their hands all the times our training says we should. I have seen CNA’s go into rooms, begin work on patients and move on to the next room without so much as touching the faucet on the sink. I have seen gloves go on and come off without a thought of soap and water. It is actually very scary to know since we were taught how vital proper hand washing was! So, this is what I have to add to this skill information; no matter what other aids are doing and no matter how tempting it is to skip hand washing under certain circumstances, NEVER SKIP IT!

During your skills test you will be expected to do a full hand washing set. However, during the other skill sets you will only be asked to tell that this is when you would wash your hands. There are many areas in which you can make mistakes and still pass your exam, but hand washing is not one of them. If you miss the hand washing step, even though you are only announcing it, it is likely that you will not pass your exam. Hand washing is right up there with placing the call bell within the patients reach. Miss either of those steps during any skill and you may have to retest at a later date.