CNA Proper Hand Hygiene and PPE Usage 2 — Questions and Answers
Question 1: When should a CNA perform hand hygiene BEFORE donning gloves?
- Never — gloves eliminate the need for hand hygiene
- Only when hands are visibly soiled
- Before every patient contact, including before putting on gloves (Correct answer)
- Only when changing between patients
Correct answer: Before every patient contact, including before putting on gloves
Hand hygiene before donning gloves prevents contaminants on the hands from being trapped inside the gloves and reduces pathogen transfer.
The CDC recommends hand hygiene before donning gloves as part of standard precautions. Gloves can have micro-tears and pathogens can transfer during the donning process. Performing hand hygiene first ensures the lowest possible microbial load before patient contact.
Question 2: A CNA caring for a patient on droplet precautions should wear which PPE?
- Gloves only
- Gown and gloves
- Surgical mask, gloves, and gown (Correct answer)
- N95 respirator, face shield, gloves, and gown
Correct answer: Surgical mask, gloves, and gown
Droplet precautions require a surgical mask, gloves, and gown to protect against respiratory droplets that travel up to 3 feet.
Droplet precautions (used for influenza, pertussis, meningitis, etc.) require a surgical mask (not N95), eye protection if splash is anticipated, gown, and gloves. An N95 is reserved for airborne precautions (TB, measles, varicella) where particles remain suspended in air over longer distances.
Question 3: In what order should PPE be REMOVED (doffed) after caring for an isolation patient?
- Mask → gown → gloves → hand hygiene
- Gloves → gown → mask/eye protection → hand hygiene (Correct answer)
- Gown → gloves → mask → hand hygiene
- Gloves → mask → gown → hand hygiene
Correct answer: Gloves → gown → mask/eye protection → hand hygiene
Gloves are removed first because they are the most contaminated item; the gown is next; mask and eye protection last to protect the face until the end.
The CDC doffing sequence minimizes self-contamination. Gloves carry the highest pathogen load from direct patient contact. Gown removal follows, then mask or respirator (handled by straps only, not the front). Hand hygiene is performed after each removal step and again after all PPE is off.
Question 4: How long should hands be rubbed together when using alcohol-based hand sanitizer?
- 5 seconds
- 10 seconds
- At least 20 seconds or until dry (Correct answer)
- 60 seconds
Correct answer: At least 20 seconds or until dry
Hand sanitizer must be rubbed vigorously over all hand surfaces until the product is completely dry — approximately 20–30 seconds.
Alcohol-based sanitizers require friction and contact time to kill pathogens. Rubbing until the product evaporates ensures full coverage including between fingers, back of hands, and fingernails. Applying sanitizer and immediately touching a surface leaves the process incomplete.
Question 5: A CNA has just assisted a patient with a C. difficile (C. diff) infection. Which hand hygiene method is required?
- Alcohol-based hand sanitizer — faster and equally effective
- Soap and water — required because alcohol does not kill C. diff spores (Correct answer)
- Either method is acceptable per facility preference
- No hand hygiene needed if gloves were worn throughout
Correct answer: Soap and water — required because alcohol does not kill C. diff spores
Alcohol-based sanitizers are NOT effective against C. diff spores. Soap and water must be used to mechanically remove spores from the hands.
Clostridium difficile forms heat- and alcohol-resistant spores. Soap and water mechanically removes spores through friction and rinsing. Facilities with C. diff outbreaks often mandate soap and water for all staff contact with affected patients, even when gloves are worn.
Question 6: Which area of the hand is MOST often missed during handwashing?
- Palm center
- Back of the hand
- Fingertips and under the nails (Correct answer)
- Wrist
Correct answer: Fingertips and under the nails
Studies consistently show fingertips and the area under the nails are the most frequently missed and most heavily colonized areas during handwashing.
Fingertips and subungual areas harbor the highest pathogen concentrations and are most involved in direct patient contact. WHO hand hygiene guidelines specifically include a step for rubbing fingertips against the opposing palm to address this gap. Short, clean nails and no artificial nails reduce subungual contamination.
CNA Proper Hand Hygiene and PPE Usage 2
When should a CNA perform hand hygiene BEFORE donning gloves?