Objectives

Provide ongoing training to staff members on handwashing and universal health precautions.
Model general hygiene practices.
Observe and provide feedback on general hygiene practices.

Learn

Teach

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.

Model

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 that 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 involve using barriers to prevent contact with body fluids from another person, as well as cleaning and sanitizing contaminated surfaces.

Barriers you or staff members might use to help prevent bodily fluid contact might include:

Moisture-resistant disposable diaper table paper
Disposable towels
Gloves
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.

Observe

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.

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.

A Range of Hygiene Practices

It is important to help all staff follow hand hygiene practices.

Scenario Review

Scenario	You saw: All children are gathered at the table for snack. Teacher brings cups of water over to the table from the sink. Children are interested in the cups and end up putting their hands in the cups. Teacher passes dirty cups out to children.
You Say	What you might say: “Snack is a great time to build community, so it’s great that the kids are all gathered together with you. That’s a big time for germs, though. Let’s think of some ways to prevent the spread of illness.” “The kids were so interested in the water at snack today. How could we build on that interest in a way that doesn’t spread germs?” “I noticed some issues with the water during my visit today. Let’s talk with your team to brainstorm ways to make sure children are supervised closely once they sit at the table.”
You Do	What you might do: Provide child-safe pitchers, so water can be served “family style” once children and teacher are seated. Provide extra help during snack as staff experiment with new snack time procedures that ensure better hygiene. Bring in sensory table suggestions to try, so children will have a healthy way to explore water.

Scenario	You saw: The staff member recognized an opportunity to wash hands (prior to eating) and followed through. The staff member talked soothingly throughout the interaction and described what she was doing to the infant. The staff member washed the infant’s hands for the appropriate length of time and followed all procedures (i.e., turned faucet off with towel).
You Say	What you might say: “You modeled really important healthy habits today. It’s so important to help kids learn to wash their hands before eating—even from the youngest age.”
You Do	What you might do: Encourage the staff member to invite new infant staff into her classroom to observe health practices.

Scenario	You saw: The staff member wore a glove while helping a child with a scrape. The staff member promoted some independence by encouraging the child to clean the scrape herself. The countertop was contaminated by the glove; the staff member did not dispose of glove right away.
You Say	What you might say: “You took a great first step helping the little girl today. It’s important to wear gloves whenever we deal with blood. Let’s talk about the steps that are important once you’ve had contact with blood…” “It’s important to watch out for your own safety when you are helping children. We should protect ourselves every time by being very careful about wearing gloves and washing hands.”
You Do	What you might do: Provide additional training on bloodborne pathogens, gloving procedures, etc. Provide posters to hang in the room about gloving procedures and handwashing. Continue to monitor and provide feedback.

Scenario	You saw: Staff member is engaged in a meaningful conversation with two siblings. A third child begins to offer a cookie to the children. No children in the interaction have washed their hands.
You Say	What you might say: “The cookie exchange happened fast today, but it’s important to make sure kids know they should wash their hands before every snack. Sometimes all it takes is a quick reminder.” “It’s important to be consistent about handwashing. Let’s think of ways we can make sure kids get the message.”
You Do	What you might do: Help staff think of ways to make sure snack happens in specific locations that are convenient to handwashing. Review the program’s policies on external food. Help provide reminders to children about handwashing.

Scenario	You saw: Snack area is near sinks. Sinks and towel dispenser are automated, so children shouldn’t have to touch surfaces. All supplies are stocked and available.
You Say	What you might say: “Your snack arrangement really promotes independence. The kids know to wash their hands and get their own food.” “I saw every child wash their hands without any reminders today.” “I noticed the youth were all touching the sink to get it to work. Do you think there’s an issue with the sensor, or do you think the kids just need a reminder not to touch it?”
You Do	What you might do: Talk to maintenance about any problems with the automated sinks and dispensers if sensors are not sensitive enough.

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, they have demonstrated competency on this lesson.

Explore

It can be helpful to practice difficult conversations to build confidence when monitoring hygiene in your program. Read the scenarios in the Tough Talk activity and respond to the questions. Think of the conversation that you would have with the staff members.

When Talk Gets Tough

Practice having difficult conversations around hygiene

Apply

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 poster from Caring for our Children. Ensure this guide is posted in your program where appropriate.

Hand Hygiene Monitoring Tool

Use this tool to focus your observations around proper handwashing

Gloving Procedures

Share and post this gloving poster from Caring for Our Children for your program

Glossary

Alcohol-Based Hand Sanitizer:

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

Bloodborne:

Carried or transmitted by the blood

Contaminate:

To infect or soil with germs in or on the body, on environmental surfaces, on articles of clothing, or in food or water

Re-contamination:

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

References & Resources

Aiello, A. E., Coulborn, R. M., Perez, V., Larson, E. L. (2008). Effect of Hand Hygiene on Infectious Disease Risk in the Community Setting: A Meta-Analysis. American journal of public health, 98(8), 1372–1381. https://doi.org/10.2105/AJPH.2007.124610

American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. (2023). CFOC Standards Online Database. Aurora, CO; National Resource Center for Health and Safety in Child Care and Early Education. https://nrckids.org/CFOC

Aronson, S. S., Bradley, S., Louchheim, S., & Mancuso, D. (Eds.). (2012). Model Child Care Health Policies (5th ed.). Washington, DC: National Association for the Education of Young Children. Pennsylvania Chapter of the American Academy of Pediatrics.

Aronson, S. S., & Spahr, P. M. (Eds.). (20102). Healthy Young Children: A Manual for Programs (5th ed.). Washington, DC: National Association for the Education of Young Children.

Blackwell, C., Goya-Tocchetto, D., & Sturman, Z. (2017). Nudges in the restroom: How hand-washing can be impacted by environmental cues. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3007866

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

Childcare Aware. (n.d.). Healthy Childcare. https://www.childcareaware.org/our-issues/health-nutrition/

Extension Alliance for Better Childcare. (2019). Cleaning, Sanitizing, and Disinfecting in Childcare. https://childcare.extension.org/cleaning-sanitizing-and-disinfecting-in-child-care/