Chapter 3: Health Promotion and Protection
3.2.2 Hand Hygiene
18.104.22.168: Handwashing Procedure
Children and staff members should wash their hands using the following method:
- Check to be sure a clean, disposable paper (or single-use cloth) towel is available;
- Turn on clean, running water to a comfortable temperature (1);
- Moisten hands with water and apply soap (not antibacterial) to hands;
- Rub hands together vigorously until a soapy lather appears, hands are out of the water stream, and continue for at least twenty seconds (sing Happy Birthday silently twice) (2). Rub areas between fingers, around nail beds, under fingernails, jewelry, and back of hands. Nails should be kept short; acrylic nails should not be worn (3);
- Rinse hands under clean, running water that is at a comfortable temperature until they are free of soap and dirt. Leave the water running while drying hands;
- Dry hands with the clean, disposable paper or single use cloth towel;
- If taps do not shut off automatically, turn taps off with a disposable paper or single use cloth towel;
- Throw the disposable paper towel into a lined trash container; or place single-use cloth towels in the laundry hamper; or hang individually labeled cloth towels to dry. Use hand lotion to prevent chapping of hands, if desired.
The use of alcohol based hand sanitizers is an alternative to traditional handwashing (with soap and water) if soap and water is not available and if hands are not visibly dirty (4,5). A single pump of an alcohol-based sanitizer should be dispensed. Hands should be rubbed together, distributing sanitizer to all hand and finger surfaces and hands should be permitted to air dry. Alcohol based hand sanitizer dispensers should be kept out of reach of children, and active supervision of children is required to monitor effective use and to avoid potential ingestion or inadvertent contact with eyes and mucous membranes (6).
Situations/times that children and staff should wash their hands should be posted in all handwashing areas.
Use of antimicrobial soap is not recommended in child care settings. There are no data to support use of antibacterial soaps over other liquid soaps.
Children and staff who need to open a door to leave a bathroom or diaper changing area should open the door with a disposable towel to avoid possibly re-contaminating clean hands. If a child can not open the door or turn off the faucet, they should be assisted by an adult.
RATIONALERunning clean water over the hands removes visible soil. Wetting the hands before applying soap helps to create a lather that can loosen soil. The soap lather loosens soil and brings it into solution on the surface of the skin. Rinsing the lather off into a sink removes the soil from the hands that the soap brought into solution. Acceptable forms of soap include liquid and powder.
Alcohol-based hand sanitizers do not kill norovirus and spore-forming organisms which are common causes of diarrhea in child care settings (4). This is sufficient reason to limit or even avoid the use of hand sanitizers with infants and toddlers (children less than 2 years of age) because they are the age group at greatest risk of spreading diarrheal disease due to frequent diaper changing. Hand washing is the preferred method. However, while hand sanitizers are not recommended for children under the age of 2, they are not prohibited.
Pre-moistened cleansing towelettes do not effectively clean hands and should not be used as a substitute for washing hands with soap and running water. When running water is unavailable or impractical, the use of alcohol-based hand sanitizer (Standard 22.214.171.124) is a suitable alternative.
Outbreaks of disease have been linked to shared wash water and wash basins (7). Water basins should not be used as an alternative to running water. Camp sinks and portable commercial sinks with foot or hand pumps dispense water as for a plumbed sink and are satisfactory if filled with fresh water daily. The staff should clean and disinfect the water reservoir container and water catch basin daily.
Single-use towels should be used unless an automatic electric hand-dryer is available.
The use of cloth roller towels is not recommended because children often use cloth roll dispensers improperly, resulting in more than one child using the same section of towel.
TYPE OF FACILITYCenter, Large Family Child Care Home
RELATED STANDARDS126.96.36.199 Situations that Require Hand Hygiene
188.8.131.52 Assisting Children with Hand Hygiene
184.108.40.206 Hand Sanitizers
220.127.116.11 Handwashing Sinks
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
- Centers for Disease Control and Prevention. Handwashing: Clean hands save lives. CDC.gov Web site. http://www.cdc.gov/handwashing/. Updated September 27, 2017. Accessed October 23, 2017.
American Academy of Pediatrics. Hand Hygiene In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. . 31st Edition. Itasca, IL:American Academy of Pediatrics; 2018: 148-149, 154, 164
- Centers for Disease Control and Prevention. Guideline for hand hygiene in health-care settings recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA hand hygiene task force. MMWR. 2002;51(RR16).
- American Academy of Pediatrics. Managing infectious diseases in child care and schools: A quick reference guide. Aronson SS, Shope TR, eds. 2017. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Show me the science-When and how to use hand sanitizer. CDC.gov Web site. http://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html. Updated July 13, 2017. Accessed October 23, 2017.
- Santos C, Kieszak S, Wang A, Law R, Schier J, Wolkin A. Reported adverse health effects in children from ingestion of alcohol-based hand sanitizers — United States, 2011–2014. MMWR Rep 2017;66:223–226. DOI: http://dx.doi.org/10.15585/mmwr.mm6608a5.
- Ogunsola FT, Adesiji YO. Comparison of four methods of hand washing in situations of inadequate water supply. West Afr J Med. 2008(27):24-28.
Content in the STANDARD was modified on 8/9/2017.