How long should handwashing last at minimum?

20 seconds. Handwashing should last a minimum of 20 seconds (the time it takes to sing "Happy Birthday" twice). This allows enough friction and soap contact to remove pathogens.

When caring for a patient with C. difficile, which hand hygiene method is REQUIRED?

Soap and water handwashing. Soap and water handwashing is REQUIRED for C. diff because alcohol-based hand rub does NOT kill C. diff spores. The friction from handwashing physically removes the spores.

Why should you use a paper towel to turn off the faucet after handwashing?

To prevent recontaminating your clean hands. The faucet handle was touched with dirty hands before washing. Using a paper towel to turn it off prevents recontaminating your freshly cleaned hands. This is a critical step on skills exams.

4.2 Hand Hygiene | CNA (Certified Nursing Assistant) | Free Exam Prep

Hand Hygiene

Hand hygiene is the single most important practice for preventing the spread of infection. It is required before and after every patient contact and is almost always tested on the CNA skills exam.

Why Hand Hygiene Matters

80% of infections are transmitted by hands
Proper hand hygiene can reduce healthcare-associated infections by 50%
It protects patients, yourself, and your family
It's required by law and facility policy

Types of Hand Hygiene

Method	When to Use	Duration
Handwashing with soap	Hands visibly soiled, before eating, after restroom, C. diff care	20 seconds minimum
Alcohol-based hand rub (ABHR)	Hands not visibly soiled, between patients	Until dry (15-30 seconds)

When to Perform Hand Hygiene

The WHO "5 Moments" for Hand Hygiene:

Moment	When	Why
1. Before patient contact	Before touching patient	Protect patient from your germs
2. Before aseptic task	Before wound care, catheters	Prevent introducing germs
3. After body fluid exposure	After contact with blood, urine, etc.	Protect yourself
4. After patient contact	After touching patient	Prevent spreading germs
5. After touching environment	After touching bed, table, rails	Environment can harbor germs

Handwashing Technique (20 Seconds Minimum)

Step-by-step handwashing:

Step	Action	Duration
1	Wet hands with warm water	2-3 seconds
2	Apply soap to palm	1-2 seconds
3	Rub palms together	2-3 seconds
4	Rub back of each hand	2-3 seconds
5	Interlace fingers, rub between	2-3 seconds
6	Rub backs of fingers	2-3 seconds
7	Rub thumbs	2-3 seconds
8	Rub fingertips in palm	2-3 seconds
9	Rub wrists	2-3 seconds
10	Rinse thoroughly	3-5 seconds
11	Dry with paper towel	2-3 seconds
12	Turn off faucet with paper towel	1-2 seconds

Critical steps (automatic failure if missed):

❌ Not using friction (rubbing)
❌ Not washing for 20 seconds
❌ Recontaminating hands on faucet

Alcohol-Based Hand Rub (ABHR)

ABHR is effective and convenient but not for all situations:

When to use ABHR:

Hands are NOT visibly soiled
Between patient contacts
Before putting on and after removing gloves

When ABHR is NOT effective:

Clostridium difficile (C. diff) - Soap and water required
Norovirus - Soap and water more effective
Hands visibly dirty or soiled
Before eating or after restroom

ABHR technique:

Apply product to palm (follow manufacturer's directions)
Rub hands together covering all surfaces
Continue until hands are dry (don't wipe off)

Nails and Jewelry

Item	Requirement	Reason
Fingernails	Short, clean, no polish	Bacteria harbor under nails and polish
Artificial nails	Not allowed	High bacteria counts, difficult to clean
Rings	Plain band only or none	Bacteria hide under rings
Watches/bracelets	Remove or push up	Can't wash under them

Common Hand Hygiene Mistakes

Mistake	Why It's a Problem
Not washing long enough	Doesn't remove enough germs
Missing areas	Fingertips, thumbs, between fingers often missed
Touching faucet after washing	Recontaminates clean hands
Not drying thoroughly	Wet hands transfer more germs
Using ABHR on soiled hands	Can't remove visible contamination
Using ABHR for C. diff	ABHR doesn't kill C. diff spores

Hand Care

Frequent hand hygiene can damage skin:

Use moisturizers (facility-approved)
Report skin breakdown to supervisor
Damaged skin harbors more bacteria
Avoid hot water (warm is better)
Pat dry, don't rub

CNA

1Introduction to the CNA Exam

2Role and Responsibilities

3Communication and Interpersonal Skills

4Infection Control

5Safety and Emergency Procedures

6Personal Care Skills

7Basic Nursing Skills

8Mental Health and Cognitive Care

9Legal and Ethical Considerations

Key Takeaways