- Provide ongoing training to staff members on handwashing and universal health precautions.
- Model general hygiene practices.
- Observe and provide feedback on general hygiene practices.
Handwashing is one of the best ways to prevent the spread of illness. However, many staff members do not follow proper handwashing procedures. You will need to make sure that staff members know the best ways and times to wash their hands.
When handwashing occurs as it should, children and youth will be healthier and staff will miss fewer days of work. All direct care staff taking this Healthy Environments course will have read about handwashing in this lesson. Nevertheless, you may need to provide follow-up support. Assess staff’s understanding of this important habit as you review and discuss with them their Explore and Apply activities.
You can model healthy habits for staff and children. The skills you and staff 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). Make sure you wash your hands:
- Each time you enter a classroom or program
- Before and after helping a child with toileting or diapering
- After using the restroom
- Before and after touching animals
- Whenever your hands are visibly dirty or soiled
- After sneezing, coughing into your hand, or blowing your nose
- After helping a child who has sneezed
- After coming in from outdoors
- Before and after assisting with food service or eating
- Before and after feeding an infant or young child
- Before and after helping a child, youth, or staff member who has been injured
- After removing disposable gloves
- Before and after administering medication
- After handling garbage or cleaning
Also be sure that you always follow proper handwashing procedures. Wash your hands with liquid soap and water for at least 20 seconds, and always turn off the faucet with a paper towel. Display visual representations, such as photos or a handout, showing each step in handwashing. It is best to use photos of children in the classroom demonstrating the steps. Discuss with your administrator when and under what conditions children, youth, or staff members may use alcohol-based hand sanitizers (i.e., on field trips when water is not available).
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, staff members should wash their 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 they should wear gloves. Staff should wash hands immediately after contact with blood, body fluids, excretions, or wound dressings and bandages. Once again, it is important that staff wear gloves if they may come into contact with blood or body fluids which may contain blood.
Standard and Universal Precautions
Another way to reduce the risk of transmission of microorganisms (germs) that can cause infection is to practice standard or universal precautions. Standard precautions cover all situations where you may come into contact with body fluids, but universal precautions apply specifically to contact with blood, and does not apply to contact with feces, nasal secretions, sputum, sweat, tears, urine, saliva, or vomit unless these body fluids also contain blood. In child care settings, standard precautions involves using barriers to prevent contact with body fluids from another person, as well as cleaning and sanitizing contaminated surfaces. You can read more about standard precautions in the Standard and Universal Precautions as they Apply to Child Care Settings fact sheet available in the Learn Activities section below.
Barriers you or staff members might use to help prevent bodily fluid contact might include:
- Moisture-resistant disposable diaper table paper
- Disposable towels
- Plastic bags, securely sealed
Staff should always use disposable non-porous gloves when blood or body fluids containing blood may be involved. Gloves are optional for diapering and contact with other bodily fluids described above, but adhere to your Service or program guidelines regarding the use of gloves. Gloves are not necessary for feeding human breast milk.
Whenever gloves are worn, make sure staff practice good hand hygiene; wearing gloves does not remove the need to properly wash hands after the task is complete. A resource that illustrates the appropriate procedure for removing gloves to reduce contamination is available in the Apply Activities section below.
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. Use the Hand Hygiene Monitoring Tool in the Apply section of this lesson to carefully observe this important health habit. When you are in the classroom, monitor when and how hands are washed. Record what you see on the Hand Hygiene Monitoring Tool. Then discuss your observation with the staff member. Provide positive feedback about what you saw. Then discuss ways the staff member can make sure he or she uses proper handwashing techniques each and every time.
Case Example: Hand Hygiene
Let's take some time to follow a case example about a classroom that struggled with hand hygiene. Watch the Case Example: Hand Hygiene video and then read about how a coach or trainer might respond to these teachable moments.
Case Example Step 1: Make a Plan
The trainer, coach, or administrator and the classroom team sat down together and looked at the data from the Hand Hygiene Monitoring Tool. The team did not realize that they had missed so many important opportunities for handwashing. The trainer, coach, or administrator and the team developed a plan for improving their use of hand hygiene practices. Here's a sample of their plan:
Goal: To teach children how and when to wash their hands
- Invite our trainer, coach, or administrator (or program health consultant) to come talk to the children about germs and handwashing. She will teach: when to wash hands, how to wash hands, and why it's important.
- Continue teaching by playing a game at group time about handwashing. Make picture cards that show activities that require handwashing (using the toilet, having snack, petting an animal, sneezing into your hand, etc.) and activities that don't require handwashing (reading a book, giving a hug, etc.). Have children guess whether they need to wash their hands before or after doing these activities.
- Hang posters around the room that use pictures to show the handwashing steps (post one over the box of tissues, one in the restroom, one near the door). Take pictures of children in our classroom following the steps and use them to create our own posters.
- Add handwashing into our lesson plans for cooking activities.
- Ask our trainer, coach, or administrator to do surprise visits and give us feedback on whether we followed all handwashing procedures every time.
Case Example Step 2: Provide Feedback
This classroom's trainer, coach, or administrator used the Hand Hygiene Monitoring Tool during several classroom visits. As you heard in the video, the trainer, coach, or administrator noticed that a child did not wash his hands after wiping his nose at the table. The trainer, coach, or administrator also noticed that children and staff members did not wash their hands before a cooking activity. Staff members also did not remind children to wash their hands after licking their fingers. The trainer, coach, or administrator then used that data to help the staff develop an improvement plan about handwashing. Based on the video you saw, a trainer, coach, or administrator might say:
Case Example Step 3: Offer Resources
The trainer, coach, or administrator continued to observe in the classroom and used the Hand Hygiene Monitoring Tool to make sure staff members and children washed their hands. The trainer, coach, or administrator provided the posters available in the Apply section for staff members to post in their rooms.
Additional Examples of Hand Hygiene
The Range of Hygiene Practices video provides examples of staff members who fall along a continuum of compliance with handwashing procedures. You could practice using the Hand Hygiene Monitoring Tool to record what you see. Then read about ways you might address the issue with each staff member.
No matter what you see in classrooms or programs, continue to teach, model, and observe healthy habits. When staff members are ready, spend some time in their classrooms or programs. Use the Hand Hygiene Monitoring Tool to observe and provide feedback. When staff members consistently follow all procedures, every time, they have demonstrated competency on this lesson.
It can be helpful to practice difficult conversations to build confidence when monitoring hygiene in your program. Download and print the Tough Talk activity. Read the scenario. Then imagine the conversation you would have with Travis. Write what you would say in the text boxes on the left. Write what you think he would say in the boxes on the right. Try it once with a cooperative response from Travis. Then try writing your responses as if Travis had become upset, angry, or defensive. Compare your responses to the Tough Talk Answers form.
When Talk Gets Tough
It is important that you monitor and support compliance with handwashing procedures. Use the Hand Hygiene Monitoring Tool to focus your observation during a classroom visit. Record the instances of correct and complete handwashing. This brief checklist can be used to support staff that have completed the Healthy Environments course but may need additional support on handwashing procedures. This checklist can also be used by Training & Curriculum specialists and Program managers to provide feedback to staff members that do not provide direct care to children in the program. (If staff need support with this process, consult Lesson Two of their track in the Virtual Lab School. Or you may want to direct them to CDC posters at https://www.cdc.gov/handwashing/posters.html). Provide feedback to the staff member about what you saw. Add these observation forms to a staff member’s training file to document competence and progress with this skill.
It is also important, when you or staff wear gloves, to apply and remove them appropriately. Review the attached Gloving Procedures from Caring for our Children (4th Edition). Ensure this guide is posted in your program where appropriate.
Hand Hygiene Monitoring Tool
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 http://nrckids.org
Aronson, S. S., Bradley, S., Louchheim, S., & Mancuso, D. (2002). Model Child Care Health Policies. (4th ed.). Washington, DC: National Association for the Education of Young Children.
Aronson, S. S. & Spahr, P. M. (2002). Healthy Young Children: A manual for programs. Washington, DC: National Association for the Education of Young Children.
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
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.
National Association for the Education of Young Children. (2007). Keeping Healthy: Families, Teachers, and Children. [Brochure]. Washington, DC: NAEYC.
North Carolina Child Care Health and Safety Resource Center (May 2009). For more information, contact 800-367-2229
Ritchie, S. & Willer B. (2008). Health: A guide to the NAEYC early childhood program standard and related accreditation criteria. Washington, DC: National Association for the Education of Young Children.