Module 4 · Reference — Hand Hygiene & Sharps Handling
Module 4 · Reference Page
Hand Hygiene & Sharps Handling
Estimated time: 15 minOSHA-Required Topic
Hand hygiene is the single most important infection control practice in healthcare. Sharps handling is the practice that prevents the most consequential workplace injuries — the kind that lead to bloodborne exposures. Both are mandated under OSHA and Joint Commission standards, and both come up regularly on CFCN and infection control competency assessments. This page is a visual reference for the standards.
The WHO 5 Moments for Hand Hygiene
The World Health Organization framework defines exactly when hand hygiene is required during a patient encounter. It's the standard taught in every accredited nursing program and every infection control curriculum.
WHO 5 Moments for Hand Hygiene
Adapted from World Health Organization, 2009
Moment 1
Before touching the patient
When approaching to begin foot inspection or care, before any skin contact.
Moment 2
Before clean/aseptic procedure
Before donning gloves to start nail trimming, debridement, or any procedure with broken-skin risk.
Moment 3
After body fluid exposure risk
After contact with broken skin, blood, or other body fluids — even through gloves.
Moment 4
After touching the patient
When leaving the patient's immediate zone, after the procedure is complete.
Moment 5
After touching patient surroundings
After contact with the chair, table, or other items in the patient's zone — even if you didn't touch the patient directly.
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"Patient zone" vs "healthcare zone"
The WHO framework draws a conceptual line around the patient and the surfaces they contact (chair, table, drape). Anything inside that zone is considered colonized with the patient's flora. Hand hygiene happens whenever you cross that line — entering, exiting, or interacting with anything inside it.
Handwashing Technique
The CDC and WHO both specify the steps and duration. The most common reason hand hygiene fails isn't that nurses skip it — it's that they rush through it.
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Soap-and-Water Handwashing
For visibly soiled hands and after restroom use
Step 1
Wet hands
Warm running water; avoid hot water (skin damage over time).
Step 2
Apply soap
Enough to lather all hand surfaces. Liquid soap from a dispenser preferred.
Step 3
Lather thoroughly
Palms, backs of hands, between fingers, fingertips, thumbs, wrists. At least 20 seconds.
Step 4
Rinse and dry
Rinse with running water; dry with single-use towel; turn off faucet with the towel.
Duration: 40–60 seconds totalUse when: Hands visibly soiled, after restroom, after exposure to spore-forming pathogens
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Alcohol-Based Hand Rub
The default for clinical hand hygiene
Step 1
Apply product
Palmful of alcohol-based rub (60–95% alcohol). Cover all surfaces.
Step 2
Rub palm-to-palm
Then back of each hand with palm of the other.
Step 3
Interlace fingers
Palm to palm with fingers interlaced; backs of fingers to opposing palms.
Step 4
Thumbs and fingertips
Rotational rubbing of each thumb; fingertips against palm. Continue until dry.
Duration: 20–30 seconds, until hands are dryUse when: Hands are not visibly soiled — the default for most clinical hand hygiene
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Alcohol rub is preferred for routine hand hygiene
For most clinical hand hygiene moments, alcohol-based hand rub is more effective and faster than soap and water. Reserve soap-and-water for visibly soiled hands or after exposure to spore-forming organisms (e.g., C. difficile) — alcohol doesn't kill spores. For a typical foot care visit, alcohol rub between glove changes is appropriate and efficient.
🚫 Common hand hygiene errors
Skipping hand hygiene before donning gloves ("the gloves will protect me")
Not washing or sanitizing for the full required duration — 20 seconds is longer than it feels
Wearing rings, bracelets, or watches that prevent thorough cleaning of skin underneath
Long or artificial nails — both harbor pathogens and make hand hygiene less effective
Cracked or chapped skin from over-washing — use moisturizer; broken skin is a portal for pathogens to YOU
Using gloves as a substitute for hand hygiene — gloves don't replace the WHO 5 Moments
Sharps Handling Protocol
Sharps injuries are the most common mechanism of bloodborne pathogen exposure for healthcare workers. Most are preventable. The protocol below comes directly from OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) and CDC sharps injury prevention guidance.
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Container Placement
Within arm's reach of the working hand at point of use
At eye level when possible — never below knee level
On a stable surface that won't tip
Away from foot traffic and reach of children/visitors
FDA-cleared, puncture-resistant, leak-proof, color-coded (red) and labeled with the biohazard symbol
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Handling Technique
Drop sharps directly into the container — never into your other hand first
Use one-handed scoop technique if needles must be recapped (rare in foot care)
Never bend, break, or cut sharps before disposal
Never push items into the container with your hand — use the container's lid mechanism
If a sharp falls, retrieve it with forceps or a magnetic retrieval tool — not your hands
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Fill Levels
Replace at the manufacturer's fill line (typically 3/4 full)
Never overfill — sharps protruding from the opening cause injuries
Close, seal, and label the container before transport
Document the date the container was sealed
Keep replacement containers stocked nearby
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Disposal & Transport
Transport sealed containers via licensed medical waste hauler or designated facility
Never place sharps containers in regular trash, recycling, or sewage
Keep records of disposal per state regulations
For mobile/home visits: transport sealed containers back to clinic for disposal
Patient sharps disposal: refer to state programs or pharmacy take-back when applicable
When to Replace the Sharps Container
Replace at the manufacturer's fill line — never wait until full
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Most sharps injuries happen during disposal, not during use
The CDC's sharps injury surveillance data consistently show that the disposal step is the highest-risk moment — overfilled containers, recapping needles, retrieving items that fell on the floor. Place your sharps container thoughtfully, replace it at the fill line, and never reach blindly into a container.
Biohazard Waste: What Goes Where
Not everything generated during a foot care visit is biohazard waste. Over-classifying creates unnecessary cost; under-classifying creates regulatory and infection risk.
Waste type
What it is
Where it goes
Sharps
Anything that can puncture or cut: nail nipper blades sent for disposal, scalpels, needles, broken glass
Items saturated with blood or infectious material (gauze with significant blood, contaminated drapes)
Red biohazard bag — requires licensed medical waste pickup
Soiled but not saturated
Used gloves with no visible blood, drapes without visible body fluid contamination
Regular trash (per facility policy and state law — check local requirements)
Single-use abrasives
Pumice, emery boards, single-use files used between patients
Regular trash if no visible blood; biohazard bag if blood-contaminated
Patient handouts & paper
Educational materials, paperwork without PHI
Regular trash or recycling. Anything with PHI: shredder/HIPAA disposal
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State and facility policies vary
Medical waste regulations are primarily state-level. What counts as "regulated medical waste" in California may differ from Texas. Always defer to your state's regulations and your facility's written waste management policy. When in doubt, treat as biohazard — over-classification is safer than under-classification, even if it costs more.
Educational Disclaimer
The information on this website and any communication with RNscrub Foot Care is provided for educational and informational purposes only. It is not a substitute for medical advice, diagnosis, or treatment. Patients are always encouraged to consult with their primary care provider or appropriate specialist for individual clinical decisions.
References
World Health Organization. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge. 2009. (Source of the WHO 5 Moments framework.)
Centers for Disease Control and Prevention. Hand Hygiene in Healthcare Settings. (Updated guidelines and resources.)
Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. MMWR. 2002;51(RR-16):1–45.
Occupational Safety and Health Administration. Bloodborne Pathogens Standard. 29 CFR 1910.1030.
Centers for Disease Control and Prevention. Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. 2008.
U.S. Food and Drug Administration. Sharps Disposal Containers. (Regulatory guidance for FDA-cleared containers.)
U.S. Environmental Protection Agency. Medical Waste. (Federal guidance and state regulation summary.)
