Concordia Home Care and Nursing Services LLC   Concordia Health Mobile Lab

Concordia Edvantage Training Academy                  Concordia Luxury Home

Mon-Fri: 9AM to 5PM

Hand Hygiene

Hand Hygiene



Participants will be able to:
• Recognize why, as a home health aide (HHA), it’s important to practice infection control
• Demonstrate how to properly wash hands or use a hand rub
• Identify when and how to use standard precautions
• Recognize general methods to prevent the spread of infection


As an HHA, you care for people in ways they need care—bathing, grooming, feeding, and attending to all sorts of needs. This care involves close contact and touching, often with individuals who are ill, who have weak immune systems, or who simply cannot afford to get sick.

You must recognize that you are a common factor among all your patients; this means that you can carry germs from one patient to another, even if you do not feel ill. Many illnesses such as the flu can be transmitted before symptoms develop. This means you must be on guard and use methods to prevent the spread of infection at all times. Once someone is sick, it’s too late.

You don’t have to use a hazmat suit all day long, but you should take simple yet effective measures every day. This in-service gives general and practical advice for stopping the spread of infection and explains effective measures to take and why they are so important.


Many people have weakened immune systems for a lot of different reasons, including cancer, HIV, and receiving organ transplants. People who have undergone an operation have a higher chance of developing an infection. People with diabetes have a difficult time healing from skin infections and often suffer from unusually high blood sugar during illness. Older adults often cannot recover quickly from illness. Older people who come down with the flu or a chest infection might have a harder time staying hydrated and breathing. People who are susceptible to the flu can die from it. These are just a few examples of why it’s critical to protect your patient population and yourself from getting ill.

Keeping a distance from those who are sick is a good prevention method but one that is difficult for healthcare workers to implement. Some illnesses, such as the flu, are spread through droplets in the air. Other illnesses are contracted only through bodily fluids. Many are spread by hand. Knowing and diligently applying the principles of hand hygiene and standard precautions is the best way of protecting your patients and yourself.

Hand Hygiene

Hand hygiene is the most effective way of preventing the spread of infection. Germs can stay on your hands and be transferred. Think of all the things and people you touch in a day. You use the bathroom, are in public spaces, handle money, care for patients, touch your face, touch doorknobs, and food—the list is endless. Practicing good hand hygiene helps protect your patients, yourself, your family, and others. You might think you don’t always have time to clean your hands, but in all the things you’re rushing around to do—caring for your patient—you might be causing more harm than good if you don’t take a moment for hand hygiene.

You should wash your hands:
• Before and after caring for a patient
• After caring for personal needs, such as using the toilet, blowing your nose, covering a sneeze, combing hair, etc.
• Before consuming, handling, or serving food or drink
• Upon return from public places
• Before and after each shift or upon leaving one home and entering another
• After any contamination or after handling waste materials, secretions, drainage, or blood
• After handling soiled items, including linens, clothing, bedpans, urinals, or garbage
• Before and after wearing gloves
• Before and after touching wounds

The CDC has guidelines for hand hygiene. They include:
• Wet hands with warm water.
• Apply soap.
• Rub your hand’s palm to palm.
• Put one hand over the other, both palms facing down. Interlock your fingers and rub.
• Put your hand palm to palm, interlace your fingers, and rub.
• With fingers together, grab one set of fingers with the other, palms facing each other.
• Grab your thumb with your other hand and twist; repeat with the opposite hand.
• With closed fingers, cup your hand and rub the tips of those fingers into the palm of your other hand. Do this to the opposite hand.
• Rinse hands.
• Dry hands thoroughly.
• Use a towel to turn off the faucet.

Always wash your hands when they are visibly soiled. Hand washing should take 15 to 20 seconds.

Alcohol hand rub products are more effective than hand washing with soap unless the:
• Hands are visibly soiled
• Person has a condition that is known or potentially spread by spores, such as norovirus or Clostridium difficile diarrhea

Please note that the effect applies only to alcohol-based products. Avoid sanitizers in which the active ingredient is triclosan or others that do not contain 60%–95% alcohol. Higher concentrations are less potent because they contain less water than lower concentrations. The reduction in water causes some of the original germ-killing properties to be lost or diminished.

The following are hand rub guidelines:
• Apply the rub to your palm.
• Rub hands together, palm to palm.
• Put one hand over the other, both palms facing down. Interlock your fingers and rub.
• Put your hand palm to palm, interlace your fingers, and rub.
• With fingers together, grab one set of fingers with the other, palms facing each other.
• With closed fingers, cup your hand and rub it into the palm of your other hand. Do this to the opposite hand.
• Continue to rub for the length of time recommended by the manufacturer, until hands are dry, or for at least 20 seconds. Hands must be dry for the sanitizer to be effective.

Clean personal equipment such as a stethoscope or bandage scissors with alcohol after use. Clean nonwashable items with disinfectant wipes.

Standard Precautions

Be familiar with the principles of standard precautions and select the correct personal protective equipment (PPE) for the task.

Guidelines for standard precautions
Routinely cleanse hands.
Wear gloves for any contact with blood, body fluids, secretions, excretions (except sweat), mucous membranes, or nonintact skin. Also:
• Anytime your hands are cut, scratched, chapped, or have a rash
• When cleaning up blood or body fluid spills
• When cleaning potentially contaminated equipment

Make sure your gloves are intact and fit properly. Gloves that are torn or too large or small will not protect you.

Change gloves:
• After caring for each patient
• Before touching noncontaminated articles or environmental surfaces
• Between tasks with the same patient if there is contact with infectious materials
• When caring for multiple wounds on the same patient
• Any time your gloves become soiled for any reason

Dispose of gloves properly, according to agency policy.
Wear a waterproof apron or gown for procedures that are likely to produce splashes of blood or other body fluids:
• Remove a soiled apron or gown as soon as possible and dispose of it properly
• Wash your hands

Wear a mask and protective eyewear or a face shield for procedures that are likely to produce splashes of blood or other moist body fluids. The surgical mask covers both the nose and the mouth. The mask is used once and discarded. If it becomes damp during use, change it. Masks lose their effectiveness when moist.

Goggles or a face shield helps protect the mucous membranes of the eyes from splashes or sprays of blood and other body fluids. Wear a surgical mask with goggles or a face shield to protect the nose and mouth. Your eyeglasses, if you wear them, will not protect you.

A good rule to follow is that a surgical mask may be worn without protective eyewear, but protective eyewear is never worn without a surgical mask. Apply the mask first, followed by the protective eyewear. Some one-piece, disposable masks have a protective eye shield attached to them.

You should:
• Know where to obtain PPE.
• Correctly apply the PPE.
• Be familiar with the principles of standard precautions and select the correct PPE for the task.

Do not contaminate environmental surfaces with used PPE. Correctly remove and discard the PPE before leaving the work area. Place used PPE in the proper container for laundering, decontamination, or disposal. A plastic bag is usually the best option.

Remember that humans need to be touched. It is not necessary to wear gloves 100% of the time unless needed to apply the principles of standard precautions.

Ebola Raises PPE Removal Questions

In 2014, an epidemic of the deadly Ebola virus in Liberia resulted in the evacuation of patients to other countries. At the time of this writing, this includes patients in Spain (two), Germany (two), France (one), the UK (one), Norway (one), and the United States (four).

A visitor from Liberia became the first person in the United States to be diagnosed with the disease. After his death, two nurses who cared for him were diagnosed with Ebola, though luckily both survived. CDC dignitaries were quick to note that a breach in the protocol must have been responsible for the transmission of the virus in both instances. “It’s important to wear it, but it’s important also that when you take it off, you take it off properly,” CDC insists. “It is conceivable that you could be protected while you’re doing everything you need to do with the patient, and then as you remove the protective material that could be a point of vulnerability.” Since the technique used for the removal of PPE was implicated by the CDC in the contamination, a federal inquiry is underway in the United States.

Wear Gloves

Gloves are an important part of patient care. They are worn to avoid:
• Picking up a pathogen from a patient
• Giving a patient a pathogen that is on your hands
• Picking up a pathogen and contaminating environmental surfaces and personal property on the hands
• Passing a pathogen to a coworker, visitor, family member (or other people) from your hands

Clean exam gloves are generally used in the home. Most of the gloves used today are made of nitrile, vinyl, and other synthetic products. Inform your employer if you are allergic to latex. They will provide another type of glove. Disposable gloves are to be used only once and may not be washed for reuse. Even if he or she is properly gloved, an HHA who has broken skin should be sure to inform the care team members. Gloves do not take the place of proper hand hygiene. You must clean your hands before and after touching a patient, even if you wear gloves.

Gloves will become contaminated while providing care to a patient, so it’s important to remove gloves immediately after providing that care. Gloves must be changed if they become damaged or soiled in any way. It’s easy to contaminate the patient’s room with gloved hands, so HHAs must remove gloves, wash hands, and replace gloves in the presence of open sores and cuts, before touching bodily fluids, and before and after:
• Assisting with or performing mouth care
• Assisting with or performing perineal care
• Performing any other personal care
• Shaving a patient
• Disposing of soiled linens, dressings, or pads

Putting on gloves:
• Wash hands
• Place glove on one hand
• With your gloved hand, put the other glove on
• Look for tears and holes and immediately replace gloves that are damaged

Taking off gloves:
• Touching the outside of one glove with the gloved fingers of the other hand, pull the glove down from the wrist.
• As the glove comes off, roll it inside out.
• Hold the removed glove in your opposite gloved hand.
• With bare fingers, grasp the inside of your glove and roll it down from the wrist, turning it inside out. You will now have one glove in your hand, clean side out, with the other glove inside it.
• Dispose of used gloves properly.
• Wash hands again.

Sick Days

If you feel sick, you might think that your patients still need you and the gallant thing to do is to work anyway. However, you should assess how sick you are and take the necessary precautions. Discuss with your supervisor whether you should work at all that day.


Healthcare workers should be vaccinated against many diseases, including the flu. Because you provide care in close quarters with many patients, your having the flu creates a danger to a wider net of people who are more vulnerable to illness. Every healthcare worker who doesn’t come down with the flu could stop countless others from catching it.


Always wipe down and clean high-traffic areas or hazardous areas, such as surfaces in bathrooms and kitchens. Wipe items that are used for meals or snacks, such as tray tables or trays attached to wheelchairs, with soap and water after each use. Keep kitchen eating and food preparation surfaces clean. Wiping down doorknobs, cabinet knobs, counters, remote controls, phone receivers, cell phones, toilet flush handles, faucets, keyboard, mouse, light switches, and handles to appliances such as the microwave, oven, or toaster often is always a good idea. Linens, eating utensils, and dishes belonging to those who are sick should not be shared without washing thoroughly first.

Sneezing and Coughing

Never sneeze or cough into your hands. If you do it accidentally, be sure to immediately sanitize or wash them. Using a tissue is best, but if you can’t use a tissue, use the crook of your arm. This is an area unlikely to touch others and it provides a better shield to prevent contact with others. Either way, clean the hands or elbows with alcohol. Discard tissue correctly. Try to cough and sneeze away from others. Even if the cause is allergies, you can still transmit microbes you might be carrying.

General Infection Control Practices

To limit the spread of infection, follow your agency’s infection control procedures. Some tips to remember include:
• Basic hand washing: Wash your hands before and after patient care. Use an alcohol-based hand sanitizer if your hands are not visibly dirty.
• Use warm water and soap when washing hands. Hot water from the tap is not hot enough to kill germs and can cause skin problems.
• Cough or sneeze into a tissue and then discard the tissue. Clean your hands with alcohol. If you do not have a tissue, cough into your elbow or upper sleeve.
• Wash your hands with soap and water after coming in contact with any body fluids from your patient or yourself. This includes an unprotected sneeze or cough.
• Wear gloves for patient care that may include body fluids.
• Wear a surgical mask for the care of patients with flu.
• Try not to touch your face. Germs from your hands can enter the mouth, nose, or eyes through contact.
• Do not share drinks or food.
• Use gloves when emptying wastebaskets at the patient’s home to avoid contamination by used tissues and other items carrying germs.
• Use gloves when cleaning the patient’s home to avoid contact with germs on the surface of chairs, tables, toilets, wheelchairs, and other items. Remember that germs can travel many feet from a sneeze.

Patient Education

Stopping the spread of illness is everyone’s job. Teach your patient to use alcohol hand cleaner or wash hands often and to keep a clean home. Make sure the patients tell you when they’re not feeling well. Teach them this content. Be sure they keep surfaces clean and keep liquid soap in the bathroom.

Outcomes and the HHA

Infection control prevents harm to the patient and others. The last thing a patient needs is to develop an infection. Viruses like the flu can make recuperation difficult and take longer. A recently discharged patient may have to return to the hospital. Old, young, chronically ill, and healthy persons die of the flu each year. Your role in preventing these outcomes is critical. As a constant observer, you can also alert the healthcare team if a patient has signs of infection so treatment can begin as soon as possible.

CMS’ Expectations

As a result of the Outcome and Assessment Information Set, the Centers for Medicare & Medicaid Services (CMS) reviews the quality outcomes and processes regarding the care a homecare agency provides. It also reviews potentially avoidable events. It expects that agencies use the information available for their quality improvement programs. CMS expects an agency’s quality improvement efforts to take a multidisciplinary approach to meet and improve the care needs of its patients.

Case Study

Molly is an 80-year-old married female, being cared for at home after hospitalization for pneumonia. She lives with her husband, Donald, in their lovely waterfront home. While in the hospital, she was given intravenous fluids and antibiotics. She was discharged home after just 3 days, although very weak and still with a slightly productive cough. She was able to eat small meals. Home health was called in to follow up with Molly at home.

The RN admitted her to home health care and has arranged for the HHA, Madeline, to provide assistance with personal care and activities of daily living (ADL). She left a care plan for Madeline in the home as well as talking with her in the office about Molly’s needs.

Madeline called ahead and arranged to come to the home at 11 a.m., the next day. Upon arrival, Madeline was greeted at the door by Donald, who escorted her to Molly’s bedside. She found Molly a bit groggy when speaking to her. Madeline asked where she could put her bag and proceeded to access her alcohol-based hand sanitizer and cleaned her hands, which took about 20 seconds. When fully dry, she took Molly’s vital signs and had a conversation with her.

Molly revealed that since coming home, she had developed some abdominal pain and unrelenting diarrhea. Molly reported feeling weaker since returning home, but the cough she had experienced was less and her breathing had improved. She complained of thirst.

Madeline asked to use the house phone to report the changes to her supervisor. After using the phone, she wiped it down with an antiseptic towel.

Madeline then went on to assist Molly with her bath, oral hygiene, and toileting. Prior to doing so, she put on nonsterile gloves. After the care was provided, Madeline removed her gloves with the dirty side inside and again cleansed her hands with the hand sanitizer. She then went on to the kitchen and prepared a half sandwich and cup of soup for Molly and served her, pausing to straighten Molly’s clothing and shift her sheets a bit.

Molly was assured that the RN on the case would be in contact with her physician about the diarrhea and weakness.
Madeline once again used the hand sanitizer before leaving the home.