Question

Difficulty: MediumStandard and Transmission-Based Precautions

After assisting a client who is positive for *Clostridioides difficile*, a practical nurse prepares to wash their hands with soap and water. Arrange the following steps of the hand hygiene procedure in the correct chronological sequence.

  1. 1Turn on the water and thoroughly wet the hands and wrists, keeping them lower than the elbows.
  2. 2Apply a sufficient amount of liquid soap to the palms of the hands.
  3. 3Vigorously rub all surfaces of the hands, including between the fingers and under the fingernails, for at least 20 seconds.
  4. 4Rinse the hands under warm running water, allowing the water to flow from the wrists down toward the fingertips.
  5. 5Dry the hands completely with a disposable paper towel and use a separate, dry paper towel to turn off the faucet.

Answer

The correct sequence for hand hygiene is: wet hands keeping them below the elbows, apply soap, scrub vigorously for at least 20 seconds, rinse from wrists to fingertips, and finally dry the hands and turn off the faucet with a clean paper towel.
The standard CDC procedure for handwashing ensures that hands are cleaned effectively without recontaminating them or the arms. Wetting hands first creates a base for lather, friction removes microbes, downward rinsing washes them away safely, and using a separate towel for the faucet prevents recontamination from environmental surfaces.

Step-by-Step Solution

1
Wet hands and wrists
Skin is moistened and ready for soap application.
Wetting hands first minimizes skin irritation and helps the soap lather effectively. Keeping hands below elbows prevents contaminated water from flowing back up the arms.
2
Apply liquid soap
Soap is distributed on the hands.
Adequate soap ensures sufficient coverage of all hand surfaces for effective cleaning.
3
Scrub for at least 20 seconds
Pathogens and debris are mechanically loosened.
Friction is the most important component of handwashing. A minimum of 20 seconds is required to physically remove transient flora and spores like C. difficile.
4
Rinse from wrists to fingertips
Soap and pathogens are washed away into the sink.
Water must flow from the least contaminated area (wrists) to the most contaminated area (fingertips) to prevent recontamination.
5
Dry hands and turn off the faucet
Hands are dry and remain uncontaminated.
Drying prevents microbial growth in residual moisture. Using a separate, dry paper towel to turn off the faucet ensures clean hands do not touch the contaminated faucet handle.

Key Concept

Hand Hygiene Procedure and Standard Precautions
Estimated Time:1m 0s
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