- Describe proper handwashing techniques 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 and youth in your program healthy. Handwashing stops the spread of diseases and infections, which is important for you and the children. 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 school-age staff member, 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. And the skills you teach children can also help bring these practices home.
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, or blowing your nose 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, here are a couple simple ways to cut down on the spread of those airborne germs:
- Cough into your elbow instead of your hand. School-age children and youth can be shown this technique, but they might not remember to do it all the time. It is good to model this practice to help them start healthy practices. The Centers for Disease Control and Prevention (CDC) provides a poster to help reinforce this practice available in a number of languages. See https://www.cdc.gov/flu/protect/covercough.htm for details.
- Cover sneezes with a disposable tissue if one is available. Dispose of tissues in a hands-free trash can.
Keep tissues throughout your program spaces and take them with you when you go outside to ensure school-agers have the opportunity to practice this healthy habit. You may use a lot of tissues but it's the formation of a good habit that matters. Of course, after using a tissue and throwing it away, you and the children need to wash their 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 is so severe or big 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 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 One. 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. Watch this video about why handwashing is so critical and how all children, youth and staff members should wash their hands.
When handwashing is done correctly, it can be the easiest way to help keep yourself and your children healthy. Be sure to have liquid soap, water and paper towels available, and always remember to model good handwashing techniques yourself.
When to Wash Your Hands
Proper hand hygiene will help keep you and the children healthy as it prevents the spread of disease. 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. 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). 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
- After using the restroom
- After helping a child who has had an accident, or any child that might need assistance 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 can help you and the children in your program stay 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 and youth 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 soap.
- Lather the soap well. Remember to teach children to scrub all surfaces, including the backs of their hands, wrists, between their fingers, around jewelry, and under their fingernails.
- Continue rubbing your hands for at least 20 seconds. The Red Cross and CDC suggest humming a short, simple tune like the "Happy Birthday" song from beginning to end twice. This will give you an idea of just how long 20 seconds is.
- Rinse their hands well under running water.
- Dry your hands using a clean paper towel or use an air drier. Make sure that towels are never shared. Always have an adequate supply of paper towels and soap.
- Use your towel to turn off the faucet. Then use the towel to open any doors and throw away. (Your process may vary slightly if your program uses no-touch automatic faucets.)
You should also hang photos or a poster above each sink to help remind children about proper handwashing. In the Apply section, there are examples of posters you can use in your program.
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 program 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. You can work together with school-age children to ensure everyone in your program follows proper handwashing techniques. In the Challenge, Are You Washing Right? activity, ask a coworker or even a school-age child to use the checklist to check you. You can also ask the children to use these checklists with each other to encourage one another to follow proper handwashing techniques and provide each other with supportive feedback. Remember to celebrate when staff members or children correctly complete all seven steps and when they wash their hands at the appropriate times. Share your experiences with your trainer, coach or administrator.
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 Minnesota Department of Health, U.S. Department of Agriculture and the Centers for Disease Control and Prevention 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:
- Wash Your Hands [CDC]
- Handwashing – General Posters (CDC)
Stop Germs! Stay Healthy! Wash Your Hands
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. Itasca, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association. http://nrckids.org
Centers for Disease Control and Prevention. (2015). A New CDC Handwashing Study Shows Promising Results. https://www.cdc.gov/handwashing/child-development.html
Berry, T.D., Mitteer, D.R., Fournier, A.K. Examining Hand-Washing Rates and Durations in
Public Restrooms: A Study of Gender Differences Via Personal, Environmental, and Behavioral Determinants. Environment and Behavior. 2015;47(8):923-944.
Centers for Disease Control and Prevention (2017). Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C . http://www.cdc.gov/niosh/topics/bbp/
Centers for Disease Control and Prevention (2020). Cover Your Cough. http://www.cdc.gov/flu/protect/covercough.htm
Centers for Disease Control and Prevention (2020). Handwashing: Clean Hands Save Lives. http://www.cdc.gov/handwashing/
Centers for Disease Control and Prevention (2019). Keeping Hands Clean. http://www.cdc.gov/healthywater/hygiene/hand/handwashing.html#ship
Council on Accreditation. (2018) Child and Youth Development Early Childhood Education (CYD-ECE) Standards for Health. New York: Council on Accreditation. http://coanet.org/standard/cyd-ece/4/
Council on Accreditation. (2018). Standards for Child and Youth Development Programs. Out-of-School Time. (CYD-OST) Standards for Health. New York: Council on Accreditation. http://coanet.org/standard/cyd-ost/11/
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. www.health.state.mn.us
North Carolina Child Care Health & Safety Resource Center. www.healthychildcarenc.org
U.S. Department of Agriculture (2019). Feeding infants in the child and adult care food program. https://teamnutrition.usda.gov