Texas CNA Skills (Part One): Hand-Washing, a.k.a. Hand Hygiene Instructions and Video

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Hand-washing is arguably one of the easiest and most effectual methods of infection control in healthcare facilities. Correctly-performed hand hygiene prevents the spread of harmful diseases. In fact, the overarching goal of hand-washing is to remove microbes, dirt, debris and particles from the hands by way of sufficient manual friction along with soap and warm water to prevent the spread of disease-causing germs to vulnerable patients and residents.

In addition, hand-washing happens to be a testable skill on the Texas state examination and skills evaluation test to attain certification as a certified nursing assistant (CNA). During the course of the CNA state test, the test-taker is expected to perform a full hand-washing skill sequence in front of the examiner to ensure that it is being done properly. Thus, a thorough working knowledge of correct hand-washing techniques is imperative in order for a candidate to pass the skills portion of the state exam.

Without satisfactory knowledge of hand-washing techniques, a test taker could quite possibly fail the skills portion of the state test, resulting in a disappointing loss of time, money, effort and confidence. Who wants to continually retake the CNA state exam? Not you! In other words, it would be an excellent idea to know how to perform the skill of hand-washing in the precise manner that the state test examiner wants it completed.

CNAs and other healthcare workers will need to wash their hands multiple times per work shift during the course of performing direct care. The nurse aide must perform proper hand hygiene before entering patients’ rooms, prior to exiting patients’ rooms, before and after feeding residents, after handling unclean bedding and linens, prior to performing procedures on patients, and after coming into contact with skin tears and open wounds.

Again, the rationale for hand-washing is to reduce the likelihood of transmitting infectious germs. The World Health Organization (2009) asserts that five instances are appropriate for hand hygiene: 1) prior to contact with patients and residents; 2) prior to performing clean and/or aseptic tasks; 3) after body fluid exposure risks; 4) after contact with patients and residents; 5) after making contact with patients’ surroundings.

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To successfully complete the hand-washing skill for the Texas CNA state exam, Pearson Vue (2018) asserts that this procedure should be performed utilizing the following steps in the order that has been listed below:

  1. The nursing assistant must refer to the patient by his or her name. The nursing assistant must also introduce himself or herself to the patient by name.
  2. The nursing assistant must proceed to turn on the water faucet at the sink.
  3. The nursing assistant needs to completely wet his or her hands and wrists.
  4. The nursing assistant adds a sufficient amount of soap to his or her hands.
  5. The nursing assistant must ensure all surfaces of his or her hands, wrists and fingers are lathered up for a minimum of 20 seconds while using sufficient friction. While lathering up, make sure the hands remain lower than the elbows. While lathering up, also make sure elbows and fingertips are kept down.
  6. The nursing assistant needs to clean his or her fingernails by rubbing the fingertips against the palms of the opposite hand.
  7. The nursing assistant must rinse off all surfaces of his or her hands, wrists and fingers while being sure to keep the hands lower than the elbows and the fingertips down.
  8. The nursing assistant must use dry paper towels to dry off all surfaces of his or her hands, wrists and fingers while starting at the fingertips. The nursing assistant then must proceed to dispose of the used paper towels into the wastebasket receptacle.
  9. The nursing assistant must use dry paper towels to turn the water faucet off before properly throwing the used paper towels into the wastebasket receptacle.
  10. The nursing assistant must not touch the inside of the sink during any point in time while performing the hand-washing skill in front of the examiner.


All About Medical Training. (2015). Hand Hygiene (Hand Washing) CNA Skill Video AAMT. Retrieved from https://www.youtube.com/watch?v=6ae0eODZyNQ&t=2s

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from https://home.pearsonvue.com/getattachment/73a0c524-4cbe-401a-aa5c-fe1ebf4e2517/Texas

World Health Organization. (2009). Hand Hygiene: How, Why & When? Retrieved from http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

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