CNA Skill: Hand Washing

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

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.

14 Responses to CNA Skill: Hand Washing

  1. Mary November 14, 2010 at 9:00 pm #

    Thanks to whomever posted this. I was always confused about how to do this and this shows perfectly how to do it.

    • Anne Refior-Heuser August 18, 2019 at 6:49 am #

      It’s always wash DOWN and dry DOWN. Anytime you go up, you contaminate. Best of luck to you all. Anne RN, CNA Instructor

  2. rene March 7, 2011 at 3:00 am #

    Dry from fingertips to wrist. Once you dry from fingertips to wrist you never do back down to the fingers . Its finger tips to wrist, She went up and down,

  3. LegendsOfBatman June 28, 2011 at 6:45 pm #

    Only issue I see, is the lady did not have a towel for the door handle; assuming there was a door.

  4. Mark LaClair August 26, 2011 at 2:19 am #

    The only thing I see maybe wrong is her hands rise above her elbows while washing. I have learned from this video. Thank you

  5. Hayley January 7, 2012 at 8:17 am #

    you didnt whip from the fingertip up to the wrist : o

  6. Michelle October 11, 2012 at 3:33 pm #

    I was taught that whiling washing your hands you are suppose to clean under each fingertip and continue with the washing.

  7. Bianca January 15, 2013 at 4:27 pm #

    im a medical student and this video actually helped me pass my handwashing test and i think the person who made that video should make more cause it helps people.

  8. gracey June 15, 2013 at 10:42 pm #

    hands were too high, above elbows at times, and not in a downward position. also, her drying technique was not correct. it is fingertips to wrist and can be done if done properly where you don’t go up and back down. was there enough friction I don’t know. I usually will create more than that and have watched several others use more also. other than that good video.

  9. Maryanna Quintyne July 18, 2013 at 8:56 am #

    There definitely was not enough friction and her hands were way too high. She did not rinse her hands properly…the rinsing time was too short and the drying was incorrect. Otherwise it was a good video!

  10. nat August 7, 2013 at 10:00 pm #

    Only issue I have is she never used paper towel to turn the pipe on !! Failed!!

  11. Beatriz May 9, 2020 at 10:48 pm #

    I just wish all care givers were more conscious about following procedures like hand washing to prevent the spreading of germs, a big one no washing their hands first thing before touching the telephone to clock in before starting their day or night shift “ they think it is no necessarily because they are not sick, that is their response when been asked to wash hands. Thanks for stressing this important task for care giver and everybody as far as I’m concern.

  12. JILL HENNING January 27, 2021 at 12:54 am #

    When I teach handwashing, I have the students wash in a specific order and not all over the place. For instance, rub palms together for suds, intertwine fingers washing to the tips, move to the top of one hand then the other while washing all the way to the fingertips. Next, move to the thumb, then scrub fingertips and nails against each palm, then wrists and on to using an orange stick. I do not pass them if they go back to an area that has already been washed, for example, once they finish the wrists, they cannot go back to rubbing the palms together. Then, I have them rinse fingertips to wrist, straight through the water, thumbs up, and do not allow them to “saw” the stream. This lets the water remove any soap on the medial wrist area. Then, while the hands remain over the sink, they dry from fingertips to wrists using a paper towel and patting. No skin to skin contact allowed. They toss the towel with the same hand that it originated in and do not transfer the towel from one hand to the next.

  13. MrsO June 19, 2022 at 12:04 pm #

    I have brought this up but it has been answered as “if you feel you need to”.
    With viruses on the rise, we are told in addition to washing hands frequently, cough/sneeze in elbows. We are not told to take off jackets, wash elbows, sanitize coats etc.
    Was wondering IF the sneeze/cough in elbow stays as what they want us to do, do we now wash like surgeons up to elbows?

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