Chapter 3: Health Promotion and Protection
3.2.2 Hand Hygiene
188.8.131.52: Handwashing Procedure
Frequent handwashing can help reduce the spread of illness in early care and education programs. Many diseases and illnesses are spread by not washing hands with soap and running water. Children and staff should wash their hands regularly and during key times such as toileting activities, after coughing, sneezing, or blowing nose, when hands look dirty, after playing outside, before and after eating, after touching animals or their cages, food preparation, or when giving first aid1. Children and staff should wash their hands using the following method:
- Have soap ready and a disposable paper towel or single-use cloth towel to dry hands after washing.
- Turn on clean, running water to a comfortable temperature.
- Moisten hands with water, turn off the faucet1 and apply soap to hands. If programs choose to, the water can be left running. When water supply is a concern, turn off the water before applying soap.
- Rub hands together vigorously until a soapy lather appears and continue for at least 20 seconds (sing “Happy Birthday to You” twice). Rub areas between fingers, around nail beds, under fingernails and jewelry, and on back of hands.
- Turn on the water (if it was turned off for soaping), and rinse hands under clean, running water that is at a comfortable temperature until they are free of soap and dirt.
- Turn off the faucet, and dry hands with a disposable paper towel or single-use cloth towel or air dry.2 Programs may use a paper towel or single-use cloth towel to turn off the faucet.
- Antibacterial soap, fragranced soap, bar soap, and premoistened wipes are not recommended for handwashing.
Single-use, disposable towels or single-use cloth towels should be used unless an automatic electric hand dryer is available. Cloth roller towels are not recommended.
Washbasins should not be used as an alternative to running water. Nails should be kept short, and acrylic nails are not recommended for staff.
When running water is unavailable or impractical or hands are not visibly dirty, an alcohol-based hand sanitizer (refer to CFOC Standard 184.108.40.206) is a suitable alternative.3
Routine handwashing prevents the spread of infections in early care and education programs. Running clean water over the hands removes visible soil. Wetting the hands before applying soap helps to create a lather that loosens dirt and brings the dirt into the soap. Thoroughly rinsing the hands removes the lather and dirt. Certain soaps and all premoistened wipes are not recommended for use in programs. Non-antibacterial soaps are as effective as antibacterial soap.2 Bar soaps can spread germs among children and staff. Using fragrance-free cleaning products, including soap, reduces exposure to harmful chemicals like phthalates, found in fragrances. Premoistened cleansing towelettes do not effectively clean hands and should not be a substitute for washing hands with soap and running water.
Programs may turn off the faucet during handwashing to save water. Programs do not need to leave the water running because data has not shown that a significant number of germs are transferred between hands and the faucet.2 Faucets may be turned off with or without a paper towel depending on program requirements. Research has shown that using a paper towel to turn off the faucet does not improve health.2 Cloth roller towels are often use improperly resulting in more than one child using the same section of the towel. Washbasins and acrylic nails can spread germs in early care and education programs.
Posters over the sink are helpful reminders for teaching how to wash hands. Many state and local health departments have created free posters. The CDC has printable handwashing posters: https://www.cdc.gov/handwashing/posters.html
TYPE OF FACILITYCenter, Early Head Start, Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS220.127.116.11 Diaper Changing Procedure
18.104.22.168 Procedure for Changing Children’s Soiled Underwear, Disposable Training Pants and Clothing
22.214.171.124 Situations that Require Hand Hygiene
126.96.36.199 Assisting Children with Hand Hygiene
188.8.131.52 Training and Monitoring for Hand Hygiene
184.108.40.206 Hand Sanitizers
220.127.116.11 General Requirements for Toilet and Handwashing Areas
18.104.22.168 Handwashing Sinks
Appendix J: Selection and Use of a Cleaning, Sanitizing or Disinfecting Product
Appendix K: Routine Schedule for Cleaning, Sanitizing, and Disinfecting
Centers for Disease Control and Prevention. 2022. When and how to wash your hands. CDC.gov Web site. https://www.cdc.gov/handwashing/when-how-handwashing.html
Centers for Disease Control and Prevention. 2021. Show me the science – how to wash your hands. Handwashing in community settings. CDC.gov Web site. https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html
Centers for Disease Control and Prevention. 2020. Show me the science – when & how to use hand sanitizer in community settings. CDC.gov Web site. https://www.cdc.gov/handwashing/show-me-the-science-hand-sanitizer.html
American Academy of Pediatrics. 2018. Effectiveness of a hand hygiene program at child care centers: a cluster randomized trial. AAP.org Web site. https://publications.aap.org/pediatrics/article/142/5/e20181245/38560/Effectiveness-of-a-Hand-Hygiene-Program-at-Child?autologincheck=redirected
American Academy of Pediatrics. 2018. Hand hygiene in childcare centers: nothing to sneeze at! AAP.org Web site. https://publications.aap.org/journal-blogs/blog/3142/Hand-Hygiene-in-Childcare-Centers-Nothing-to?autologincheck=redirected
Centers for Disease Control and Prevention. 2022. Clean hands and spaces: Web-based training. CDC.gov Web site. https://www.cdc.gov/hygiene/training-education/clean-hands-and-spaces.html
Centers for Disease Control and Prevention. 2022. Hand hygiene in school and early care and education. CDC.gov Web site. https://www.cdc.gov/handwashing/handwashing-school.html
Content in the STANDARD was modified on 8/9/2017, 5/17/19 and 9/21/2023.