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    • Describe proper handwashing techniques and the importance of thorough handwashing to prevent the spread of disease.
    • Recognize circumstances that require handwashing for adults and children throughout the day.
    • Describe hygiene practices and standard health precautions that prevent the spread of germs.





    Washing your hands is the most important thing you can do to keep yourself and the children in your care healthy. Handwashing stops the spread of diseases and infections. Studies find that proper handwashing decreased the occurrence of diarrhea-type illnesses in children and adults by 50 percent. It can also help prevent colds, flu, and other infections. It is essential to know how and when adults and children should wash their hands.

    Healthy habits begin in the early years, and you can teach children a great deal about how to prevent illness and infection. There are three main ways germs can enter the body: through contact with mucus from coughs and sneezes, through cuts and scrapes, and through contact with blood and other body fluids. As a family child care provider, it is important to know how to prevent the spread of illness from these sources and how to promote good hygiene practices. Maintaining clean hands is one of the most significant steps we can take to avoid getting sick and spreading germs to others. The skills you teach children can also help bring these practices home. A recent study revealed that after using a public restroom, only 31% of men and 65% of women washed their hands. (Judah et al., 2009).

    Coughs and Sneezes 

    When someone coughs or sneezes, tiny particles are released into the air. These particles can contain germs. When we breathe in these particles or touch a surface that has been contaminated, we increase our risk of getting sick. The risk increases if we then touch our eyes, nose, or mouth. To avoid the spread of disease, it is important to maintain a healthy environment with proper handwashing after sneezing, coughing into your hand, blowing your nose, or helping a child who has sneezed.

    Respiratory infections and germs are spread through coughing and sneezing. In addition to handwashing after coughing or sneezing, here are a couple simple ways to cut down on the spread of those airborne germs:

    • Cough into your elbow instead of your hand. Older toddlers can be shown this technique, but know they might not remember to do it all the time. It is good to model to help them start healthy practices.
    • Cover sneezes with a disposable tissue if one is available. Dispose of tissues in a hands-free trash can.

    Keep tissues easily accessible in your program and take them with you when you go outside to give the children in your care the opportunity to practice this healthy habit. You might go through a lot of tissues, but your effort supports the formation of a good habit. Handwashing is necessary after using the tissue and throwing it away.

    Cuts, Scrapes, and Sores 

    As wounds heal, they might drip, ooze, or drain. These fluids can spread infection and the wound itself also is susceptible to infection. The American Academy of Pediatrics (2011) recommends covering and containing any wound that is leaking. If the wound is so severe or large that it cannot be contained, the child or adult should stay home until a scab has developed. Hand hygiene is critical before and after contact with sores, cuts, or scrapes--whether your own, another adult’s, or a child’s.

    Blood and Other Body Fluids

    Blood can carry a variety of pathogens. Bloodborne pathogens include human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Transmission of these diseases in child care is rare. They are most frequently transmitted through needle sticks or when blood or other body fluid enters the body through eyes, nose, mouth, or broken skin. These diseases are not spread through saliva, sweat, or vomit. Casual contact like hugging, sharing a cup, using a public restroom, or coughing and sneezing do not spread bloodborne diseases.

    However, to promote hygiene practices and decrease the chance of contracting various infectious diseases, you should wash your hands before and after helping a child or another adult who has been injured and after handling bodily fluids of any kind (i.e., mucus, blood, vomit, saliva, urine). You should wash hands immediately after contact with blood, body fluids, excretions, or wound dressings and bandages. It is important to wear gloves when you may come into contact with blood or body fluids that may contain blood. More about the use and removal of gloves is provided in Lesson Three.

    Handwashing Procedures

    Think about everything your hands come in contact with daily. Now multiply that by all the little hands and hands of any other adult or family members, parents, and visitors to your home. That’s a lot of opportunities for the transmission of germs. Proper handwashing is the most effective way to reduce the spread of disease. 

    For handwashing to be effective, proper procedures must be followed. Although the basic steps to handwashing remain the same, your level of involvement and the exact procedure will vary depending on the developmental stage and motor control of the young child you are helping. 

    The basic steps to handwashing:

    (see the handwashing posters in the Apply section)

    • Turn on water; wet hands completely.
    • Apply liquid soap.
    • Lather well for 20 seconds, scrubbing all surfaces, including the backs of hands, wrists, between fingers, and under fingernails.
    • Rinse hands well under running water.
    • Dry hands with a disposable towel.
    • Turn off the faucet using the paper towel.
    • Discard paper towel in a hands-free or step trash can.
    For very young infants, unable to support their heads:

    When an infant is unable to hold his or her head up, or to stand at the sink, or if he or she is too heavy for you to hold at the sink, you can wash the infant’s hands by using the three-towel method. Prepare these three towels ahead of time, and use them in the following order with very young infants:

    1. One dampened and soapy for washing the infant’s hands
    2. One dampened with water for rinsing the infant’s hands
    3. One dry for drying the infant’s hands

    After this procedure, make sure to wash your own hands, following the basic steps to handwashing outlined above.

    For young infants who can support their heads but not yet stand at the sink:

    When you are able to hold an infant, but he or she cannot yet stand on his or her own at the sink:

    1. Carry the infant over to the sink. Be careful not to push the infant’s belly against the sink.

      If needed, you can aid your back by placing your foot on a stool to lift your leg and rest the infant on your knee.

    2. While holding the infant at the sink, wash the infant’s hands using the basic handwashing steps outlined above.

      Again, wash your own hands when you are finished.

    For older infants who are able to stand at the sink:

    Older infants, even those who are not yet proficient walkers but who are able to stand safely on their own, can stand at a toddler-height sink or on a safe step stool to wash their hands with help from you. You may need to help them to the sink and ensure that they are stable before beginning the handwashing steps.

    As they are still infants, you will likely have to follow the handwashing steps with them. As you do for younger infants, gently wash their hands, moving them around and explaining the various steps to handwashing so that as they grow, they can become increasingly autonomous.

    Again, wash your own hands each time you have finished assisting a child.

    For toddlers and older children who can walk up to the sink:

    Make sure there is a child-height sink or a safe step stool available for younger children. Also make sure that children follow the basic handwashing steps every time. As young children are still learning, they will likely need your assistance. You will likely need to model steps many times, and you may need to physically assist with certain steps, such as lathering.

    It is important for children to wash their hands for 20 seconds—just like adults. Teaching the children to sing a song while they wash their hands can help. “The Alphabet Song,” “Twinkle, Twinkle Little Star,” or “The Birthday Song” are all good choices. See more ideas for handwashing songs by visiting

    Every step of the handwashing procedure is important to the whole process, and a missed step can cause re-contamination and the spread of germs. For reference, a poster showing proper handwashing procedures should be posted near every sink used in your family child care program (see Apply section). Handwashing supplies should always be well stocked and accessible.


    Proper handwashing technique is important. Though it seems simple, there are several steps you must take to make sure your hands are clean.

    Proper Hand Hygiene

    This video shows proper procedures for handwashing.

    Now watch a second video to see examples of ways family child care providers protect themselves and promote healthy habits.

    Preventing the Spread of Disease

    It is important to use standard precautions to prevent the spread of disease.


    When to Wash Your Hands

    Handwashing must be a habit for both children and adults. Knowing when to wash your hands is just as important as knowing how to wash your hands. In addition to when hands are visibly soiled, there are specific times when handwashing is especially important. The American Academy of Pediatrics recommends the following: 


    • Upon arrival
    • Before and after eating, handling food, bottle feeding
    • After using the toilet, diapering
    • After handling body fluids (urine, blood, feces, vomit, mucus, saliva)
    • After coughing or contact with runny noses
    • After touching contaminated objects, such as trash cans
    • Before and after playing in water that is used by more than one person
    • After sand play, messy play
    • After playing outdoors
    • After handling animals or animal waste


    • At the start of family child care program day
    • After breaks
    • When moving from one child-care group to another
    • Before and after preparing food or beverages, including bottles
    • Before and after eating, handling food or feeding children, including bottle feeding
    • After using toilet
    • After helping children toilet
    • After helping a child wash his or her hands
    • Before and after diapering
    • Before and after contact with your own or a child's sores, cuts, or scrapes
    • Before and after helping a child or another staff member who has been injured
    • After handling bodily fluids (urine, blood, feces, vomit, mucus, saliva)
    • After coughing, sneezing, contact with runny noses
    • After helping a child who has sneezed
    • Before and after giving medication
    • Before and after applying medical ointment or cream in which a break in the skin may be encountered.
    • After removing gloves used for any reason
    • After cleaning or handling garbage
    • After handling animal or animal waste
    • Before and after playing in water that is used by more than one person
    • After handling uncooked food
    • After playing outdoors
    • After sand play, messy play

    Healthy habits are established early, so it’s important that young children are exposed to handwashing. You should also hang photos or a poster above the sink, as shown below, to help remind children about proper handwashing. In the Apply section, there are examples of posters you can use in your program.

    hand washing steps diagram

    If no sink is available (on a field trip or walk to local park, for example), check with your trainer, coach, Service, or licensing agent to see if alcohol-based hand sanitizers are approved for use in your program and for what ages of children. If these sanitizers are approved, supervise the children closely, apply only a pea-size amount in their hands, and teach them how to rub their hands together and let the sanitizer air dry. Hand sanitizers are only effective if hands are not visibly soiled. Alcohol-based hand sanitizers are not safe for infants who frequently mouth their hands; these hand sanitizers are typically recommended for use only with children older than 2.

    Respond to teachable moments as occasions arise to remind children when and how to wash their hands properly. For example, if you notice a child sneezing into his or her hands and then touching toys or other surfaces in your home, praise the child for covering their sneeze and remind them that they should wash their hands after sneezing. At the same time, make sure you follow procedures to properly clean and sanitize toys and surfaces the child may have touched after sneezing.

    As a family child care provider, when you help young children wash their hands, particularly infants and toddlers, remember to explain what you are doing and why. This important disease-fighting routine can be embedded in the responsive relationships you have with the children in your care. Model the steps, and talk through the steps with children, so they can learn with you this essential aspect of self-care and disease prevention. 



    It’s important to teach children healthy habits. You can work together with children to ensure everyone in your family child care program follows proper handwashing techniques. Use the activity, Challenge, are you washing right? to ask another adult or even a school-age child to check you as you wash your hands. You can also ask the children to use these checklists with each other to encourage one another to follow proper handwashing techniques and provide supportive feedback. These checklists are designed for school-age children who can read, but you can adapt them with pictures for younger children to use too. Remember to celebrate when children and adults correctly complete all seven steps and when they wash their hands at the appropriate times. Share your experiences with your trainer, coach or fellow providers.



    Everyone in your program should be aware of ways to prevent the spread of germs and disease. The posters below from the Minnesota Department of Health, the Centers for Disease Control and Prevention, and the North Carolina Child Care Health and Safety Resource Center can be excellent models for your own program. Hang these posters or similar ones you create near sinks and other places in your program to remind adults and children of proper hygiene practices and standard health precautions that prevent the spread of germs.


    bloodborneCarried or transmitted by the blood
    ContaminateTo infect or soil with germs in or on the body, on environmental surfaces, on articles of clothing, or in food or water
    FecalRelating to feces, stool; bodily solid waste
    Hand sanitizerAlcohol-based alternative to soap and water that might be used when sinks are not available; the sanitizer can be a liquid, gel, or foam, but it should contain at least 60 percent alcohol
    Re-contaminationTo again infect, soil with presence of infectious microorganisms (germs)
    Standard PrecautionsThe CDC’s recommended steps you should take any time you come into contact with blood or body fluids to prevent the spread of disease




    Finish this statement: You should wash your hands…


    True or false? You do not need to wash your hands if you wore disposable gloves to clean up a child’s soiled clothing or body fluids.


    Three-year-old Hattie sneezes into her hand, picks up a toy, and then rubs her eyes. What hygiene practice might stop the spread of germs?

    References & Resources

    American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2015). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs, 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. Also available at

    Centers for Disease Control and Prevention. (2015). A New CDC Handwashing Study Shows Promising Results. Retrieved from

    Centers for Disease Control and Prevention (2012). Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C. Retrieved from

    Centers for Disease Control and Prevention (2015). Cover Your Cough. Retrieved from

    Centers for Disease Control and Prevention (2016). Handwashing: Clean Hands Save Lives. Retrieved from

    Centers for Disease Control and Prevention (2011). Keeping Hands Clean. Retrieved from

    Judah, G., Aunger, R., Schmidt, WP., Michie, S., Granger, S., Curtis, V. (2009). Experimental pretesting of hand-washing interventions in a natural setting. Am J Public Health. 99(2):S405-11.

    Minnesota Department of Health Food Safety Center. Retrieved from

    North Carolina Child Care Health and Safety Resource Center. Retrieved from