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    Objectives
    • Describe proper handwashing technique 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.

    Learn

    Learn

    Know

    Handwashing

    Washing your hands is the most important thing you can do to keep yourself and the children in your classroom healthy. Handwashing stops the spread of diseases and infections, which is important for you and the children in your care. 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. As an infant and toddler caregiver, you will need to take a more active role in helping young children, particularly infants, wash their hands.

    Healthy habits begin in the early year 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, cuts and scrapes, and contact with blood and other body fluids. As an infant and toddler caregiver, it is important to know how to prevent the spread of illness from these sources and how to promote 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 healthy habits you teach infants and toddlers 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 touch our eyes, nose, or mouth. Proper handwashing after sneezing, coughing into your hand, blowing your nose, or after helping a child who has sneezed is important to maintain a healthy environment and to avoid the spread of disease.

    Respiratory infections and germs are spread through coughing and sneezing. In addition to handwashing after coughing or sneezing, use these simple techniques to cut down on the spread of 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 in the classroom and take them with you when you go outside, which allows toddlers the opportunity to practice this healthy habit. You might go through a lot of tissues but it's the formation of a good habit that matters. Of course, after using the tissue and throwing it away, you and the children need to wash hands.

    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 cannot be contained, the child or adult should stay home until a scab has developed. Hand-hygiene is critical before and after contact with your own, another staff-member's, or a child's sores, cuts, or scrapes.

    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 staff member who has been injured, and after handling bodily fluids of any kind (i.e., mucus, blood, vomit, saliva, urine), and you should wear gloves. You should wash hands immediately after contact with blood, body fluids, excretions, or wound dressings and bandages. Once again, it is important to wear gloves when you may come into contact with blood or body fluids which may contain blood. More about the use and removal of gloves is provided in Lesson 3.

    Handwashing Procedures

    Think about everything your hands come in contact with on a daily basis. Now multiply that by all the little hands, and hands of other staff, parents, and visitors in your classroom. 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 infant or toddler 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 their hands, wrists, between their fingers and under their fingernails.
    • Rinse hands well under running water
    • Dry hands with a disposable towel.
    • Turn off the faucet using the paper towel.
    • Throw paper down into trash container

    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 infants 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 into the sink.

      If needed, you can aid your back by placing your foot on a stool to lift your leg and resting the infant on your knee as you work to wash his or her hands.

    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 for 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 assure they are stable first, before beginning the handwashing steps.

    As they are still infants, you will likely have to follow the handwashing step with them, and 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, who can walk up to the sink:

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

    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: https://childcare.extension.org/using-hand-washing-songs-to-encourage-children-in-child-care-to-wash-hands-thoroughly/.

    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. A poster showing proper handwashing procedures should be posted by every adult and child sink for reference (see Apply section). In addition, handwashing supplies should always be well stocked and accessible.

    See

    As you have learned, proper handwashing at the appropriate times is the most effective way to prevent the spread of communicable diseases.

    Handwashing Done Correctly

    Watch a demonstration of proper handwashing techniques.

    Now watch as caregivers assist infants and toddlers with proper handwashing.

    Assisting With Handwashing

    It is important to appropriately help infants and toddlers learn how and when to wash their hands.

    Do

    Handwashing must be a habit for both children and staff. 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:

    Children

    • Upon arrival
    • When moving from one child-care group to another
    • 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

    Providers

    • Upon arrival to work
    • 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 infants and toddlers are exposed to handwashing. Infants rely on you to support their 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, for example), check with your supervisor to see if alcohol-based hand sanitizers are approved for use in your program, and for what ages of children. If so, 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 over 2 years of age.

    Respond to teachable moments as occasions arise in your classroom and use these as opportunities 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 classroom surfaces, praise the child for 'covering' their sneeze and remind him or her 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.

    Lastly, as an infant and toddler caregiver, remember to explain to infants what you are doing, and why, when you help infants and toddlers wash their hands. This important disease-fighting routine can be imbedded 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 this essential aspect of self-care and disease protection.

    Explore

    Explore

    It’s important to teach children healthy habits. Use the What Would You Do Next activity as you watch the What Would You Do Next video. Answer the questions on the activity and share your responses with a trainer, coach, or administrator. Then compare your answers to the suggested responses.

    What Would You Do Next

    What would you do to prevent the spread of germs?

    Apply

    Apply

    It is important to make everyone in your program aware of ways of preventing 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 & Safety Resource Center can be excellent models for your own program. Hang these posters or similar ones you create yourself near the 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.

    Glossary

    TermDescription
    BloodborneCarried or transmitted by the blood
    ContaminateTo infect or soil with microorganisms (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 hand sanitizer is an alternative to soap and water when sinks are not available. The sanitizer can be a liquid, gel, or foam, but it should contain at least 60% alcohol. Check your program policies about the use of hand sanitizers
    Re-contaminationTo again infect or soil with presence of infectious microorganisms (germs)

    Demonstrate

    Demonstrate
    Assessment

    Q1

    Which of the following helps decrease the spread of airborne germs after coughing or sneezing?

    Q2

    When should children have their hands washed?

    Q3

    What is the most effective way to reduce the spread of infection?

    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. Retrieved from http://nrckids.org

    Centers for Disease Control and Prevention. (2015). A New CDC Handwashing Study Shows Promising Results. Retrieved from https://www.cdc.gov/handwashing/child-development.html

    Centers for Disease Control and Prevention (n.d.). Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C . Retrieved from http://www.cdc.gov/niosh/topics/bbp/

    Centers for Disease Control and Prevention (n.d.). Cover Your Cough. Retrieved from http://www.cdc.gov/flu/protect/covercough.htm

    Centers for Disease Control and Prevention (n.d.). Handwashing: Clean Hands Save Lives. Retrieved from http://www.cdc.gov/handwashing/

    Centers for Disease Control and Prevention (2011). Keeping Hands Clean. Retrieved from: http://www.cdc.gov/healthywater/hygiene/hand/handwashing.html#ship

    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: www.health.state.mn.us

    North Carolina Child Care Health and Safety Resource Center. (n.d.). Publications and Resources. Retrieved from https://healthychildcare.unc.edu/resources/

    The Children's Hospital School Health Program, Denver, CO. (2005). Healthy Futures: Medication Administration Curriculum Participants Manual: Handwashing . Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-child-care/Documents/AR_Handwashingp.pdf