Infection Control for CNAs: Master Hand Hygiene & PPE

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Why This Guide Matters

Infection control isn't just a topic on the exam—it is the foundation of every single skill you perform.

• The "Indirect Care" Behavior: On the Prometric/Credentia exam, you are graded on "Standard Precautions" during every skill.
• Automatic Failure: Breaking a sterile field or contaminating your hands without correcting it is often an automatic fail.

This guide covers the two most tested skills: Hand Hygiene (Handwashing) and PPE (Personal Protective Equipment).

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1. Hand Hygiene (Handwashing)

This is usually the first skill you will perform. If you fail this, you fail the entire exam.

The Critical Steps (Automatic Fails if Missed)

1. Do NOT touch the sink with your uniform or hands at any time.
2. Do NOT flick your hands to shake off water (this spreads germs).
3. Turn off the faucet with a clean paper towel. Never touch the clean faucet handle with your wet (clean) hands.

Step-by-Step Procedure (NNAAP & Prometric Standard)

1. Address the Client: (Even if just washing hands) "I am going to wash my hands now."
2. Wet Hands: Turn on warm water. Wet wrists and hands, keeping hands lower than elbows (so dirty water runs down, not up your arms).
3. Apply Soap: Apply plenty of soap to hands.
4. Friction (20 Seconds): Rub hands together.
   • Exam Tip: You must wash for at least 20 seconds. Sing "Happy Birthday" twice or count slowly.
   • Areas to Scrub: Palms, back of hands, between fingers (interlaced), and thumbs.
   • nails: Rub fingernails against the palm of the opposite hand to clean underneath.
5. Rinse: Rinse all soap off, keeping hands lower than elbows. Do not touch the sink!
6. Dry: Grab clean paper towels. Dry form tips of fingers moving up to the wrist. Discard wet towel.
7. Turn Off Faucet: Grab a new, dry paper towel to turn off the faucet. discard.
8. Finish: Do not touch anything else.

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2. Personal Protective Equipment (PPE)

You typically need to know how to put on (Don) and take off (Doff) a gown and gloves. The order matters!

Order to DON (Put On)

"High to Low, Hands Last"

1. Gown: Unfold, put arms through, and tie the neck strings first, then the waist strings. The gown must cover your back.
2. Mask: (If required) Put on mask, pinch nose piece.
3. Goggles: (If required).
4. Gloves: Put gloves on last. Critical Step: The gloves must go OVER the cuff of the gown. No skin should be showing at the wrist.

Order to DOFF (Take Off) - Most Critical Part

"Dirty Comes Off First" The front of your gown and outside of gloves are "dirty." Your back and hands are "clean."

1. Gloves: Grasp the palm of one glove and pull it off inside-out. Hold it in the gloved hand. Slide a finger of the bare hand under the cuff of the remaining glove and peel it off. Discard.
2. Goggles/Face Shield: Remove from the back (earpieces/headband).
3. Gown:
   • Unfasten ties (Waist first, then Neck).
   • Pull the gown away from your neck and shoulders, touching only the inside.
   • Roll it into a bundle (inside out) and discard.
4. Mask: Remove from the straps behind ears.
5. Wash Hands: Immediately wash hands.

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3. The "Chain of Infection" (Written Test Concepts)

You will see 3-5 questions on the written exam about this.

• Pathogen: The germ causing disease.
• Reservoir: Where it lives (blood, lungs).
• Portal of Exit: How it leaves (cough, open cut).
• Mode of Transmission: How it travels.
  • Contact: Touching (MRSA, C. Diff).
  • Droplet: Sneezing (Flu, Meningitis).
  • Airborne: Floats in air (TB, Chickenpox).
• Portal of Entry: How it gets in (nose, mouth).
• Susceptible Host: The person who gets sick (elderly).

Exam Tip: The best way to break the chain of infection is Handwashing.

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Practice Quiz

Take the Infection Control & Safety Quiz