D. Hand Washing - Washoe County, Nevada

D. Hand Washing
1. General information
Hands are parts of the body that come into frequent contact with germs that cause
communicable illnesses. Young children have not yet learned healthy personal habits. They
suck their fingers and/or thumbs, put things in their mouths, and rub their eyes. These habits
can spread disease, but frequent and good hand washing can help reduce infection due to
these habits. Caregivers who teach and model good hand washing techniques can reduce
illness in childcare settings and schools. Gloves are not a substitute for hand washing.
Hand washing is the single most effective way to prevent the spread of infections.
Included in this section are instructions on WHEN to wash hands (see section II-7) and
pictures to demonstrate HOW TO do the correct hand washing procedure (see section II-8).
2. Childcare and school staff information
• Learn why, how, and when to correctly wash their hands and the children's hands.
• Follow a procedure that ensures safety for the infant or child.
• Teach young children to wash hands and supervise them as they do.
• Encourage children to wash hands frequently.
3. Recommendations for hand hygiene products
• Liquid soap
- Recommended in childcare and schools since used bar soap can harbor bacteria.
Regular liquid soap is effective in removing soil and germs.
- Soap and water are necessary when hands are visibly soiled.
- When using liquid soap dispensers, avoid touching the tip of the squirt spout with
- If the liquid soap container is refillable, the container and pump should be emptied,
cleaned, and dried completely before being refilled.
Antimicrobial soaps
- Are not recommended by the American Medical Association and the CDC.
- Many scientists are concerned that use of these soaps could lead to strains of
resistant bacteria. There is no need to use these soaps, which may actually do more
harm than good.
- Must be left on hands for about two minutes in order to have any effect on bacteria.
Alcohol-based hand rubs
- Use 60% to 90% alcohol (usually 70%). Read the label and follow manufacturer’s
- Advantages of alcohol-based hand rubs are:
o Require less time and are more accessible than sinks for hand washing with soap
and water.
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o Reduce bacterial counts on hands.
- Disadvantages of alcohol-based hand rubs are:
o Should not be used on visibly soiled hands since they are ineffective in the
presence of dirt, soil, or food.
o Can reduce the number of germs on hands in some situations, but sanitizers do
not eliminate all types of germs.
Any product should be safely stored out of reach of children.
Procedure for using alcohol-based hand rubs:
1. Apply enough alcohol-based hand rub to palm of one hand to wet both hands
2. Rub hands together covering all surfaces of hands and fingers.
3. Continue rubbing over all surfaces of both hands and fingers until hands are dry.
When soap and running water are not available
- When soap and running water are not readily available, for example, on a field trip, an
alcohol-based hand rub can be used. The alcohol-based hand rub must be applied
vigorously over all hand surfaces.
- If hands are visibly soiled, hands must be washed with soap and warm running water
as soon as it is available, because the alcohol-based hand rubs are not effective in the
presence of dirt and soil.
- Hand sanitizers should not be used as a replacement for thorough hand washing under warm
running water when available. No chemical substitute (sanitizer solutions) is as effective as
running water.
- DO NOT use a common water basin. The water can become contaminated very
- Use single-use paper towels to dry hands or use hand dryers.
- DO NOT use multi-use towels such as hand towels, kitchen towels or dish cloths.
4. Fingernail care for staff and children
- Keep fingernails short and clean.
- Staff should moisten cuticles with a moisturizer to avoid hangnails.
- Clear fingernail polish that is well maintained may be worn; avoid colored nail polish
since it is difficult to see dirt under nails.
- Use fingernail brushes to remove dirt and stool from under nails. Use the nailbrush
after diapering or assisting with the toilet activities, before and after food
preparation, and whenever nails are soiled.
- Artificial nails are highly discouraged as they are known to harbor germs even with
good hand washing techniques. They can break off into food and have been
implicated in disease outbreaks in hospitals. Check with the local licensing agency
regarding any food codes that may restrict staff from wearing artificial nails when
handling and preparing food.
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5. Caregiver training on how to wash hand.
• How to wash hands of children at a sink
Caregivers should train children who are developmentally able to learn personal hygiene. This
training program should teach the following hand washing procedures.
1. Wet hands with warm running water and apply soap.
2. Rub hands together with soap vigorously for 20 seconds.
3. Rinse hands well under warm running water.
4. Dry hands using a single-use paper towel or air dryer.
• How to wash hands of infants.
Caregivers should wash the hands of infants, who are unable to wash their own hands and who are
too heavy to hold safely at the hand washing sink, as follows:
1. Thoroughly wipe the child’s hands with a disposable wipe; or
2. Thoroughly wipe the child’s hands with a damp single-use towel, moistened with liquid
soap. Then wipe the child’s hands with a damp single-use towel until the child’s hand is
free of soap. Then use a dry paper towel to dry the child’s hands.
6. When to wash hands.
Caregivers should wash their hands under any of the following conditions:
- Any time their hands come into contact with blood, mucus, vomit, feces or urine;
- Before preparing or handling food;
- Before engaging in any activity related to serving food, including, without limitation,
setting the table;
- Before and after eating a meal or snack;
- After using the toilet, helping a child use the toilet, changing a diaper with or without
gloves or assisting a child with hand washing;
- After attending to an ill child;
- After handling an animal;
- After handling garbage;
- After cleaning contaminated or soiled surfaces;
- Before and after giving medication; and
- Anytime hands become visibly soiled.
Children should wash their hands under any of the following conditions:
Any time that their hands come into contact with blood, mucus, vomit, feces or urine
or garbage;
Before handling food;
Before and after eating a meal or snack;
- After outdoor play;
- After handling an animal;
- After the diaper or underwear is changed and/or after using the toilet;
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After playing in water;
After playing in a sandbox; and
Anytime hands become visibly soiled.
7. Ways for staff to keep hands healthy
Cover open cuts and abrasions less than 24 hours old with a dressing (e.g., bandage).
Use warm water, not extremely hot or cold and just enough soap to get a good lather.
Rinse and dry hands completely.
Use the soap product that is least drying to hands.
Use hand lotion regularly to keep skin moist. Use products with a squirt spout so
hands do not have contact with the container.
Wear gloves outside in the cold weather.
Wear utility gloves for direct hand contact with harsh cleaners or chemicals.
Wear work gloves when doing yard work, gardening, etc.
For more information, call Washoe County Health District-Communicable Disease Program at
(775) 328-2447.
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