CNAs and Infection Control

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So, what precisely is infection prevention? Also referred to as infection control, infection prevention is defined as the blended range of measures and techniques that aim to prevent the spread of infectious diseases. Certified nursing assistants (CNAs), medical assistants (MAs), phlebotomy technicians and other allied healthcare workers must engage in infection control measures to keep their patients safe.

Infection prevention methods are extremely important in all types of healthcare settings in order to protect the health and safety of the patients who receive care, as well as the direct care workers who deliver the majority of the hands-on care activities. This is due to the unfortunate fact that infections that are acquired in healthcare settings can result in poor outcomes such as lengthy illnesses, extended hospitalizations and untimely deaths.

Hand-washing and hand hygiene activities such as the use of alcohol-based hand rubs are the single most effective actions that allied healthcare workers can take to prevent the spread of infectious diseases in healthcare settings. Since contaminated hands are capable of spreading awful infections, allied healthcare workers greatly minimize the odds of spreading infectious diseases by performing hand hygiene before and after each patient contact.

Texas CNA Skills (Part Eighteen): Skills That Are Not Performed on Other Live People at the CNA State Test

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Candidates and test takers who have completed a nurse aide training program must attain a passing score on the National Nurse Aide Assessment Program exam, more commonly known as the CNA state test, in order to receive state certification as a certified nursing assistant (CNA) in Texas. The CNA state test consists of two parts: a written section with 70 multiple choice questions as well as a skills evaluation.

Both the written section and skills evaluation of the CNA state test must be passed in order to receive state certification. The skills evaluation requires the test taker to demonstrate five testable skills in the presence of a nurse aide evaluator (NAE) who is scoring them as he or she observes the performance of each skill. There are exactly 22 testable skills that could appear on the CNA state test in Texas, and five of them will be selected at random for the test taker to perform.

Out of the 22 testable skills, 15 of them are to be performed on a live person at the CNA state test. In other words, the vast majority of skills will be performed on a random student with whom the test taker will be partnered at the Pearson Vue testing center. This is a reciprocal process because the two partners will be performing their five skills on each other as the NAE observes the skills demonstrations for scoring purposes.

Only seven of the 22 hands-on skills are not performed on a live person at the Pearson Vue testing center during the skills evaluation portion of the CNA state test. The first skill is hand hygiene (a.k.a. hand-washing); of course, test takers will demonstrate how to wash their own hands in front of the NAE. Thus, hand hygiene is not done on another live person. Keep in mind that all test takers will be required to complete the hand hygiene skill due to the emphasis on infection prevention.

Moreover, the personal protective equipment (PPE) skill, which requires the test taker to don and doff a gown and a pair of gloves properly, is not performed on another live person. The test taker will be dressing oneself in the PPE items before demonstrating how to appropriately remove and dispose of them. Another skill that will not be performed on a live person at the CNA state test is denture care. Rather, the test taker will demonstrate how to correctly provide care for an upper or lower denture.

Measurement and recording of urinary output is yet another skill that the test taker will never perform on a live person at the testing center. The test taker will be called upon to accurately measure the amount of simulated urine in front of the NAE before recording the numeric result. Measuring and recording urinary output is considered one of the five measurement skills that requires correct documentation at the Pearson Vue testing center in order to achieve a passing score.

Due to concerns that revolve around privacy, safety and infection control, the skills of catheter care, perineal care and applying an elastic stocking to one leg will always be performed on a mannequin at the CNA state test. In essence, these three skills are not done on a live person at the Pearson Vue testing center. This bit of knowledge often relieves test takers since they would feel uncomfortable if a random student wiped their most private areas in front of a NAE during a perineal care skill demonstration.

Do you want to become a nursing assistant in two weeks in the DFW area? Call Legacy Healthcare Careers at (682)626-5266 where you will be trained to pass the Texas CNA state examination on your first attempt.

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

Pearson Vue. (2018). Texas Nurse Aide Candidate Handbook. Retrieved from

World Health Organization. (2009). Hand Hygiene: How, Why & When? Retrieved from

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