Caring for Our Childen (CFOC)

Chapter 3: Health Promotion and Protection

3.2 Hygiene

3.2.2 Hand Hygiene Situations that Require Hand Hygiene

Content in the STANDARD was modified on 8/23/2016, 8/9/2017, 10/18/2018 and 01/22/2019.


All staff, volunteers, and children should follow the procedure in Standard for hand hygiene at the following times:

a. On arrival for the day, after breaks, or when moving from one child care group to another

b. Before and after

  1. Preparing food or beverages
  2. Eating, handling food, or feeding a child
  3. Giving medication or applying a medical ointment or cream in which a break in the skin (eg, sores, cuts, scrapes) may be encountered
  4. Playing in water (including swimming) that is used by more than one person

c. After

  1. Diapering*
  2. Using the toilet or helping a child use a toilet
  3. Handling bodily fluid (mucus, blood, vomit) from sneezing, wiping and blowing noses, mouths, or sores
  4. Handling animals or cleaning up animal waste
  5. Playing in sand, on wooden play sets, or outdoors
  6. Cleaning or handling the garbage
  7. Applying sunscreen and/or insect repellent

d. When children require assistance with brushing, caregivers/teachers should wash their hands thoroughly between brushings for each child. 

Situations or times that children and staff should perform hand hygiene should be posted in all food preparation, hand hygiene, diapering, and toileting areas. Also, if caregivers/teachers smoke off premises before starting work, they should wash their hands before caring for children to prevent children from receiving thirdhand smoke exposure (1).

*Hand hygiene after diaper changing must always be performed. Hand hygiene before changing diapers is required only if the staff member’s hands have been contaminated since the last time the staff member practiced hand hygiene (2).

Hand hygiene is the most important way to reduce the spread of infection. Many studies have shown that improperly cleansed hands are the primary carriers of infections. Deficiencies in hand hygiene have contributed to many outbreaks of diarrhea among children and caregivers/teachers in child care centers (2).

Child care centers that have implemented good hand hygiene techniques have consistently demonstrated a reduction in diseases transmission (2). When frequent and proper hand hygiene practices are incorporated into a child care center’s curriculum, there is a decrease in the incidence of acute respiratory tract diseases (3).

Hand hygiene after exposure to soil and sand will reduce opportunities for the ingestion of zoonotic parasites that could be present in contaminated sand and soil (4).

Thorough handwashing with soap for at least twenty seconds using clean running water at a comfortable temperature removes organisms from the skin and allows them to be rinsed away (5). Hand hygiene with an alcohol-based sanitizer is an alternative to traditional handwashing with soap and water when visible soiling is not present.
Hand sanitizer products may be dangerous or toxic if ingested in amounts greater than the residue left on hands after cleaning. It is important for caregivers/teachers to monitor children’s use of hand sanitizers to ensure the product is being used appropriately (6).

Alcohol-based hand sanitizers have the potential to be toxic due to the alcohol content if ingested in a significant amount (6). As with any hand hygiene product, supervision of children is required to monitor effective use and to avoid potential ingestion or inadvertent contact with eyes and mucous membranes (6).
Infectious organisms may be spread in a variety of ways:
  1. In human waste (urine, stool);
  2. In body fluids (saliva, nasal discharge, secretions from open injuries; eye discharge, blood);
  3. Cuts or skin sores;
  4. By direct skin-to-skin contact;
  5. By touching an object that has live organisms on it;
  6. In droplets of body fluids, such as those produced by sneezing and coughing, that travel through the air.
Since many infected people carry infectious organisms without symptoms and many are contagious before they experience a symptom, caregivers/teachers routine hand hygiene is the safest practice (7).
While alcohol-based hand sanitizers are helpful in reducing the spread of disease when used correctly, there are some common diarrhea-causing germs that are not killed (e.g. norovirus, spore-forming organisms) (7). These germs are common in child care settings, and children less than 2 years are at the greatest risk of spreading diarrheal disease due to frequent diaper changing. Even though alcohol-based hand sanitizers are not prohibited for children under the age of 2 years, hand washing with soap and water is always the preferred method for hand hygiene. 
Center, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS Toothbrushes and Toothpaste Handwashing Procedure Assisting Children with Hand Hygiene Training and Monitoring for Hand Hygiene Hand Sanitizers Use of Tobacco, Electronic Cigarettes, Alcohol, and Drugs
  1. Mayo Clinic. 2010. Secondhand smoke: Avoid dangers in the air.
  2. Aronson, S. S., T. R. Shope, eds. 2017. Managing infectious diseases in child care and schools: A quick reference guide, 4th Edition.Elk Grove Village, IL: American Academy of Pediatrics.
  3. American Academy of Pediatrics. Enterovirus D68 In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 331-334, 658, 692

  4. Palmer, S. R., L. Soulsby, D. I. H. Simpson, eds. 1998. Zoonoses: Biology, clinical practice, and public health control. New York: Oxford University Press.
  5. Centers for Disease Control and Prevention. 2015. Handwashing: Clean hands save lives.
  6. 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 Morb Mortal Wkly Rep 2017;66:223–226. DOI:
  7. American Academy of Pediatrics. Hand Hygiene In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st Edition. Itasca, IL:  American Academy of Pediatrics; 2018: 148-149, 154, 164


Content in the STANDARD was modified on 8/23/2016, 8/9/2017, 10/18/2018 and 01/22/2019.