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Staying Healthy: Proper Hygiene

The most important part of your job is to keep children safe and healthy. Hand hygiene is a simple way to prevent the spread of disease. You can encourage and model healthy habits like handwashing for young children. This lesson focuses on proper handwashing techniques for adults and children. It also addresses healthy habits and general hygiene practices for responding to children with colds, cuts and scrapes, and children who are bleeding.

  • Describe proper handwashing technique and the importance of thorough handwashing in preventing 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 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.

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, cuts and scrapes, and contact with blood and other body fluids. As a preschool teacher, 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.

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 preschoolers 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 (2019) 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 Three. 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.


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 child development professionals 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

Proper hand hygiene keeps you and children healthy as it prevents the spread of disease. The skills you teach children can also help bring these practices home. A recent study indicated that environmental and behavioral influences play a role in the hand-washing practices of both men and women and that neither wash their hands for the recommended 20 seconds by the CDC after using a public restroom (Berry et al., 2015). Knowing when to wash your hands is just as important as knowing how to wash your hands. Preventing the spread of disease depends on being vigilant about handwashing. You should wash your hands:

  • When you get to work in the morning or reenter the room after a break
  • When you move to another room with a different group of children
  • Whenever your hands are visibly dirty or soiled
  • Before and after preparing food
  • Before and after eating, handling food, or feeding a child
  • Before and after giving medication
  • 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
  • Before and after playing in water
  • Before and after handling animals or cleaning up animal waste
  • Before and after diapering
  • After using the restroom
  • After helping a child with toileting
  • After handling bodily fluids of any kind (i.e., mucus, blood, vomit, saliva, urine)
  • After playing in sand or outdoors
  • After handling garbage or cleaning
  • After removing disposable gloves
  • After handling uncooked food
  • After helping a child wash his or her hands
  • After sneezing, coughing into your hand, or blowing your nose
  • After helping a child who has sneezed
  • After coming in from outdoors

Teach Children How to Wash Their Hands

When you teach children how to wash their hands, you are providing them with an important life skill. This skill will help keep you and the other children healthy. You should teach the children in your care to follow the same handwashing procedures you follow. This lets you be a model for good hygiene practices. Just like you, children should wash their hands when they arrive in the morning and throughout the day as described above.

To help develop good hygiene practices, you should make sure a child-height sink or a safe step is available to the children. Make sure children follow these steps every time:

  • Children should get their hands completely wet in the stream of water.
  • Apply liquid soap.
  • Lather the soap well.
  • 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.
  • Remember to teach children to scrub all surfaces, including the backs of their hands, wrists, between their fingers and under their fingernails.
  • Rinse their hands well.
  • Dry their hands with a disposable towel.
  • Use your towel to turn off the faucet.

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. If so, supervise the children closely 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.

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.


It’s important to teach children healthy habits. Watch the What Would You Do Next video and answer the questions in the What Would You Do Next activity. Share your responses with your trainer, coach, or administrator. Then compare your answers to the suggested responses.


It is important to make everyone in your program aware of ways to prevent the spread of germs and disease. The posters below from the North Carolina Child Care Health & Safety Resource Center, Minnesota Department of of Health, the Centers for Disease Control and Prevention, and the U.S. Department of Agriculture 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. Additional posters, including specific instructions for washing hands after touching animals (including reptiles, rodents, etc.) are also available at the following links:


Carried or transmitted by the blood
To infect or soil with germs in or on the body, on environmental surfaces, on articles of clothing, or in food or water
Hand sanitizer:
Alcohol-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
To again infect or soil with presence of infectious microorganisms (germs)
Standard Precautions:
The 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. (2019). Caring for Our Children: National health and safety performance standards; Guidelines for early care and education programs, 4th ed. American Academy of Pediatrics; Washington, DC: American Public Health Association.

Berry TD, Mitteer DR, Fournier AK. (2015). Examining Hand-Washing Rates and Durations in 
Public Restrooms: A Study of Gender Differences Via Personal, Environmental, and Behavioral Determinants. Environment and Behavior. 47(8):923-944. 

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

Centers for Disease Control and Prevention (2017). Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C .

Centers for Disease Control and Prevention (2020). Cover Your Cough.

Centers for Disease Control and Prevention (2020). Handwashing: Clean Hands Save Lives.

Centers for Disease Control and Prevention (2019). Keeping Hands Clean.

Minnesota Department of Health Food Safety Center.

North Carolina Child Care Health & Safety Resource Center.

U.S. Department of Agriculture (2019).  Feeding infants in the child and adult care food program.