Module 4 · Reference — Hand Hygiene & Sharps Handling

Module 4 · Reference Page

Hand Hygiene & Sharps Handling

Estimated time: 15 min OSHA-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.

"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.

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 total Use when: Hands visibly soiled, after restroom, after exposure to spore-forming pathogens

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 dry Use when: Hands are not visibly soiled — the default for most clinical hand hygiene

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.

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

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

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

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

Disposal is a leading — and highly preventable — cause of sharps injuries

Surveillance data (EPINet/CDC) show sharps injuries occur most often during use of the device, then in the window after use but before disposal, then at disposal — with as many as a third linked to disposal: overfilled containers, recapping, or retrieving items that fell on the floor. The disposal-related injuries are among the most preventable — 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

FDA-cleared sharps container (red, biohazard-labeled)

Regulated medical waste

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

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

This lesson is provided for professional continuing education and informational purposes only. It is intended to support knowledge development in foot care nursing and does not constitute clinical advice, legal advice, or regulatory guidance.

This course content does not replace, supersede, or serve as a substitute for: the California Board of Registered Nursing (BRN) Nurse Practice Act and current BRN regulations (rn.ca.gov); California state laws and health codes governing nursing practice; county and local public health department requirements applicable to your practice setting; your facility's policies, protocols, and procedures; or your individual scope of practice as defined by your nursing license, credentials, and employer authorization.

Verify before practicing. Clinical guidelines, regulatory requirements, and scope-of-practice rules change over time. You are responsible for verifying all clinical information against current BRN regulations, California law, county requirements, and your facility's policies before applying any content from this course in practice. When in doubt, consult your supervisor, your facility's compliance team, or the California Board of Registered Nursing directly at rn.ca.gov.

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; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings. MMWR Recommendations and Reports. 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.)

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