Hand Hygiene: CNA Skills

• PACIFIC HEALTH EDUCATIONAL CENTER CNA Skills List (Rev. 03/2025) is strictly for PHEC students reference use only

General Reminders

• Explain the procedure to the resident by speaking clearly and maintaining face-to-face contact whenever possible
• Make sure the evaluator can see the skills you are performing
• If a step or procedure is missed, a correction to the skill can be made before stating "DONE"

SKILL 1 - HAND HYGIENE (HAND WASHING)

• This skill is performed using water at the sink
• Stand in front of the sink, keep your distance, and make sure your uniform does not touch the sink counter area
• Turn the water faucet on, using moderate running water to avoid splashing
• Wet both hands and wrists thoroughly
• Apply soap to both hands
• Hands should be positioned lower than elbows with fingers pointing downwards
• Avoid touching the inside of the sink at any time during handwashing
• Lather all surfaces of the hands, perform with friction for at least 20 seconds, starting with:
• Palms
• Between the fingers
• Back of the hands
• Fingertips by rubbing fingertips against palms
• Wrists
• Rinse all surfaces of your hands and wrists, and do not shake the water off
• SAY and Perform: "I will use a paper towel to dry one hand thoroughly starting from the fingertips, hand, palm, and wrist"
• Throw the paper towel in the trash
• SAY and Perform: "I will get a 2nd paper towel with my DRY hand, to dry the other hand thoroughly starting from the fingertips, hand, palm, and wrist"
• Throw the paper towel in the trash
• SAY and Perform: "I will get a 3rd paper towel to turn off the faucet"
• Throw the paper towel in the trash

SKILL 2 - APPLY KNEE-HIGH ELASTIC STOCKING

• This skill is performed with Susie or Betsy
• Knock before entering
• Verbalize washing hands
• Identify yourself
• Provide privacy
• Identify the resident by asking their name and checking the wristband
• Explain to the resident that you will be applying the knee-high elastic stocking
• Get the elastic stocking from inside the drawer
• Place the bed to comfort level, verbalizing while holding the remote to act as if raising the bed
• Uncover one of the resident's legs, the one near you
• Roll, gather, or turn the elastic stocking inside-out, then locate and hold the heel part of the stocking
• Apply the stocking over the toes, foot, heel, and adjust
• SAY and Perform: "I will make sure the heel part of the stocking is over the resident's heel, and the toes are in the toe open area of the stocking"
• SAY and Perform: "Without over-extension of the limbs and joints, I will pull the stocking slowly, smoothly, gently, and finish with no twists and wrinkles."
• Cover the resident's leg

SKILL 3 - ASSIST TO AMBULATE using TRANSFER BELT (Gait Belt)

• Knock before entering
• Wash hands
• Identify yourself
• Provide privacy
• Identify the resident by asking their name and checking the wristband
• Explain to the resident that you will help them ambulate, walk 10 steps toward the door and back
• Get the gait belt in the drawer and place it in your pocket
• SAY and Perform: "I will make sure the wheels of bed are locked"
• Place the bed to safety/low level, verbalize this while holding the remote to act if lowering the bed
• Uncover the resident
• Lower the side rail on your side of the bed
• SAY and Perform: "On the count of 3, I want you to sit at the side of the bed" by helping the resident move to the side while supporting the back of the knee and neck
• Assist the resident to wear non-skid shoes while sitting on the side of the bed
• SAY and Perform: "I will make sure the resident's feet are flat on the floor," and visibly check feet before lifting the resident
• Place the gait belt securely around the resident's waist
• SAY and Perform: "I will make sure the gait belt is no looser than 2 fingers on each side,” adjust and check if your 2 fingers can fit between the gait and the resident's waist at both front and back
• Stand in front of the resident and hold the gait belt on both sides
• SAY and Perform: "On the count of 3, I want you to stand up” and maintain the stability of the resident's legs by standing in front, knee to knee or toe to toe with the resident, so as not to slip when standing
• Stand slightly behind the resident, place one hand holding the gait belt at the front and the other hand at the back side for support.
• Ambulate the resident 10 steps away from the bed while counting
• After ambulating, assist the resident to walk back to the side of the bed
• SAY and Perform: "On the count of 3, I want you to sit down” and assist in removing the non-skid shoes
• Remove the gait belt from the resident and place at designated area
• Assist the resident to lay down, supporting the back of the knee and neck
• Raise the side rail
• Cover the resident with a blanket
• Place the bed to safe/low level
• Undo privacy
• Place call light within reach
• Wash hands

SKILL 4 - ASSIST with the USE of BEDPAN

• Knock before entering
• Wash Hands
• Identify yourself
• Provide privacy
• Identify the resident by asking their name and checking the wristband
• Explain to the resident that you will be helping them use the bedpan
• Get the toilet paper and wipes, and place them within the resident's reach, at the side of the bed
• Place the bed to a comfort level (verbalize while holding the remote to act as if raising the bed)
• Partially uncover the resident
• SAY & Perform: "On the count of 3, I will turn you to the side, please hold on to the side rail."
• Place chucks under the buttocks and return the resident to a supine position.
• Repeat turning steps to the other side and adjust the chucks under the buttocks
• Put on gloves one at a time
• Get the bedpan
• SAY & Perform: "Please bend your knees, and on the count of 3 - lift your buttocks.”
• Place the bedpan correctly under the resident's buttocks, using the wider side of bedpan to be properly positioned under the buttocks
• Remove and dispose gloves in the trash
• Wash hands
• Cover the resident
• Raise the head of the bed 35 - 45 degrees for resident comfort
• SAY: "When you are done, please wipe yourself and then press the call light."
• Place the bed to a safe/low level (verbalize while holding the remote to act as if lowering the bed
• Place call light within reach
• Wash hands
• Demonstrate to leave the room shortly...and then come back when the resident is done
• Knock
• Wash hands
• SAY: "Are you done?
• Did you wipe yourself?"
• Lower the head of the bed
• Place the bed to a comfort level (verbalize while holding the remote to act as if raising the bed)
• Partially uncover the resident
• Put on gloves one at a time
• Remove toilet paper and wipes, and place in the designated dirty
• SAY & Perform:* “Please bend your knees and on the count of 3 - lift your buttocks"
• Remove the bedpan (using 2 hands)
• Empty, wash, clean, rinse, and dry the bedpan and put it in the designated dirty area
• SAY & Perform: "On the count of 3, I will turn you to the side, please hold on to the side rail."
• Remove the chucks (by moving the resident to the other side) and dispose of them in the trash
• Reposition the resident back into a supine position
• Remove gloves and dispose of them in trash
• Wash hands
• Cover the resident
• Place the bed to a safe/low level and verbalize while holding the remote to act as if lowering the bed,
• Undo privacy
• Place call light within reach
• Wash hands

SKILL 5 - CLEAN UPPER OR LOWER DENTURE

• This skill is performed at bedside with no water
• Gather all the necessary supplies
• Emesis Basin
• CUD
• Tooth Brush
• Tooth paste
• Denture Cup
• Clean area washcloth
• Grey sink liner
• Knock before entering
• Wash hands
• Identify yourself
• Provide privacy
• Identify the resident by asking their name and checking their wristband
• Explain to the resident that you will be performing denture care
• Set up equipment to use on the tray table: Tray (to be used as sink), Emesis/kidney basin, Cup, Toothbrush, Toothpaste, Denture cup with dentures, Clean area washcloth and Sink liner (grey washcloth)
• Wash hands
• Place the sink liner inside the tray
• Turn the water on, verbalize
• Put on gloves one at a time
• Remove denture from denture cup and rinse the denture, perform & verbalize
• Place denture on the clean washcloth area
• Empty water from the denture cup and rinse/clean denture cup and lid, perform & verbalize
• Refill denture cup with water and place on clean washcloth area, perform & verbalize
• Get toothbrush and add toothpaste, perform but do not use actual toothpaste
• Hold denture in your palm, gum side is facing down
• SAY and Perform: "I will brush the front, the sides, and all other surfaces"
• After brushing, rinse denture, perform & verbalize
• Place denture back inside denture cup and cover with the lid
• Rinse the toothbrush, perform & verbalize and place on clean washcloth area
• Place in the emesis/kidney basin on the clean washcloth area
• Remove, wring the washcloth/ sink liner and place on the side
• Remove gloves and dispose in trash
• Wash hands
• Undo privacy
• Place call light within reach
• Wash hands

SKILL 6 - COUNT & RECORD RADIAL PULSE

• Knock before entering
• Wash Hands
• Identify yourself
• Provide privacy
• Identify resident by asking their name and checking their wrist band
• Explain to resident that you will be checking their pulse
• Place the bed to comfort level
• Using 2 fingers, locate radial pulse while the resident's palm is facing down and on the thumb side of the wrist
• Ask if the evaluator is ready to start
• SAY: start counting for 1 (one) full minute
• SAY: Stop and state the radial pulse count within +-4 beats of the evaluator's reading
• Return the bed to a low level
• Undo privacy
• Place the call light in the resident's reach
• Wash hands

SKILL 7 - COUNT & RECORD RESPIRATIONS

• Knock before entering
• Wash Hands
• Identify yourself
• Provide privacy
• Identify resident by asking their name and checking their wrist band
• Explain to resident that you will be counting their respirations
• Place the bed to comfort level
• Hold the resident's wrist to mimic taking radial pulse, but focus on the resident's chest while breathing
• Ask if evaluator is ready to start
• Say: "Start" counting expirations for one full minute
• Say: "Stop" and state respirations count, it must be within +-4 breaths of the evaluator's reading
• Return the bed to a low level
• Undo privacy
• Place the call light in the resident's reach
• Wash hands

SKILL 8 - DONNING & REMOVING PPE (GOWN & GLOVES)

• Knock before entering
• Wash hands
• Unfold the PPE gown, make sure the gown does not touch the ground
• Put arms through the sleeves of the gown, one arm at a time
• Tie the gown from the neck first and then tie the back
• SAY: "I will make sure my back is fully covered", (Turn and show Evaluator your back)
• Get the 1 Glove and put it on
• Get the 2 glove with your GLOVED hand and put it ON; Make sure gloves cover the cuffs of the gown
• SAY and Perform: "I will check my gloves for any tears and holes"
• Gloves removal:
• 1st Glove - glove to Glove grab the glove at the palm and remove/Dispose in the Trash
• 2nd Glove - Using 2 fingers to remove the other glove from UNDER the cuff, dispose of it in the trash
• Until the gown from the back (1st), then untie the waist
• Using two fingers, pull the sleeve of the gown from under the cuff about halfway out
• With the hand now in the sleeve, pull the sleeve off the opposite arm completely
• Grab the corners of the gown and roll it away from your body
• Dispose PPE gown in trash (Without contaminating self)
• Wash Hands

SKILL 9 - DRESS RESIDENT with a WEAK RIGHT ARM

• Knock before entering
• Wash hands
• Identify yourself
• Provide privacy
• Identify the resident by asking their name and checking the wristband
• Have the resident choose which shirt to wear
• Raise head of bed at 35 - 45
• Place bed to comfort level
• Cover the resident with the blanket before removing the gown
• SAY: "Without over-exposing the resident, I will remove the gown from the unaffected/strong arm first.”
• Tell the resident to hold the left side of the blanket and then remove the gown completely
• Discard USED gown in hamper
• Assist resident to put the sleeve on an affected arm first, before putting the sleeve on the unaffected left arm
• SAY: "I will avoid force and over extension of the limbs and joints"
• Tell the resident to lean forward, as you support the head, and fix/adjust the shirt at the back. (Only button only the top part of the shirt and make sure the resident looks decent)
• Cover the resident with the blanket
• Lower the head of the bed
• Place the bed to low level
• Redo PRIVACY
• Place call light
• Wash hands

SKILL 10 - FEED CLIENT who CANNOT FEED SELF

• Knock
• Wash hands
• Get food tray and get the food card, check name.
• Identify self (while holding card)
• Provide privacy (optional)
• Identify resident by asking name and wrist band
• SAY: “Check the consistency of the food and resident's likes, dislikes, allergies”
• Explain (resident that you will be feeding them)
• Raise the bed to (upright sitting position, 90 degrees)
• Place bed to comfort
• Place clothing protector (bib) over resident's chest and wipe hands
• Lower side rail
• Position table with food
• Position chair and sit down, at eye level
• Point out foods
• SAY: "Whats would you like to eat first?"
• (demonstrate feeding by spoon at a time)
• SAY: "Will make sure food is swallowed before the next bite, please open mouth?"
• (Offer resident some drink BETWEEN feeding)
• [Repeat, till evaluator stops]
• Wipe the resident's mouth
• (place cloth protector in hamper)
• Clean hands with wipes
• Clear TABLE
• Raise SIDE rail
• Keep head UP 30 min
• Place food tray in specified area
• Place the bed to low level
• undo privacy
• Place light
• Wash
• DONE

SKILL 11 - MODIFIED BED BATH (Face, One Arm, Hand, Underarm)

• Knock before entering Room/Area

• Wash Hands

• Identify Self

• Provide Privacy

• Ensure patient agrees/wristband

• “Bath the patient!”

• Collect Necessities

• 3 Towels (1: Chest & 1 Arm & 1 Clear Area)

• 5 Washclothes

• 1 Gown

• 1 Basin & Soap

• Ensure Set up + Have Hamper Accessible

• Get Basin (NO actual water)

• Check temperature for safety & Patient Comfort

• Place Bed to Comfortable Level

• SAY: "I shall uncover ONLY what I wash"

• Dispose Gown

• FIRST Towel - Check

• SECOND Towel - ARM cover

• *Gloves

• THREE ZONE

• 1 WIPE TOP TO BOTTOM

• 2 WIPE BOTTOM TO TOP

• 3 RINSE and Repeat

• SAY I will wash fingertips, sides, +palm, and under arm"

• Remove

• Repeat 2 more times

• Dry with 3rd and remove when done

• Remove side towel and discard

• Discard Basin

• Tie No Neck

• (if possible) Re-dress and remove trash

• Ensure SAFE level and WASH HANDS

• DONE

SKILL 12 - ELECTRONIC BLOOD PRESSURE

• NOT included in STATE Exam
• Only know what’s required

SKILL 13 - MEASURE & RECORD URINARY OUTPUT

• Knock before entering
• Wash Hands
• Don Gloves
• SAY: I will pore you over the urine into the graduate/cylinder Without “Spilling”
• Drain Body Properly and Wash it 1st
• Take to a 1-Eye Level and Note Correctly
• SAY: This is how much “Resident Output”
• Wash Basin & D.A [Dirty Area]
• REMOVE ALL ITEMS & Wash Hands
• YOU’RE DONE

SKILL 14 - MEASURE & RECORD WEIGHT AMULATORY CLIENT

• First KNOCK
• Then WASH
• Check wristband + Provide name
• SAY/Perform: “Ensure Bed/Scale is Lock!”
• And assist client with Non-Skid/Gait Belt
• WALK carefully to the destination
• SAY/Perform: Make sure the SCALE = “0”
• Help stand @ Center but Assist back after-
• Then Document carefully and WASH

SKILL 15 - PROM

Knock

• 2 Hand wash

• 3. Yourself
• 4. Privacy
• 5. Patient Name and Wrist
• 6. Explain Exercise (7/ 8) Raise Position and Uncover (One LEG!)
• 9. SUPPORT Under-Knee. SAY: “If any PAIN. -LET ME KNXOW!

• Three Times and Support with Motion!!

• 11). ( Bend (Flexion.) *Extend BACK!!!! [Repeat x THREE/3]

• [12] (Abduction.) Move AWAY, and towards AGAIN.

• 13. Then Cover and Putback.
• 14. Return Level and Place.
• 15. Re-PRIVACY

• 16 re reach

• 17 Wash

SKILL 16 - SHOULDER Range of Motion

• [1 and 2}KNOCK and WASH

• (3 and 4) Yourself + Privacy

• [5/6]. Name check and what you’ll do...

• [7]Raise and position the patient

• Check with name again

• [8/9 UnCOVER Carefully

• (Ten) Support and Ask about Pain. SAY: “Let me know if there is ANY pain? “3 Times Slow and Gentlee”

• 12. STRAIGHT Arm UP... Three Times and then DOWN! (13). (While Still Steady).

• STRAIGHTen and AWAY {From Side)!+ return

• [Fourteen]. Re-cover. -[

• 15 RAISE the SIDE

• [16]Replace position and Re.

• -[ 17] Re-COVER withPrivacy

• -[ 18]-Light. Reach

• -[ 10]And wash

• DONE

SKILL 17 – POSITION on the SIDE

• *[1.] KNOCK!!!**+ [2]. WASH!!!

• 3+4. YOU + Privacy

• [5+6]. Name + Info

• [7+ 8] Three Pillows [ Color + 2 whites] and Raise!!!!!

• *[Nine+Ten]**.UNCOVER and SAFE

• 11.Bring NEAR! Shoulder+Hips+Legs!

12. SAY.I will turn ,you on Three...

• Hold Side Rail[SLOW!] and Place

• Flip Pillow and [COLOR] BEHIND

• Leg STILL bent! and ensure Body Alligned

• Re-ALLIGN

• [21 Stand at FOOT] BODY ALLIGNED

• [22] Re-Cover

• [23]. Put LOW - [24]. PRIVACY -[25]. CALL -[26 WASH DONE

SKILL 18 Catheter Care FEMALE

• knock -wash hands -
• identify self -privacy,- ask for the client name – explain for the Resident you perform Catheter care:
• Need: basin soap
• 3,WashClothes (grey colour)
• Chuck
• 2Tawels [1 Dignity Tawel & + 1 greyclean area towel] equipment already placed on grey clean area towel and check the hamper within your reach
• get the basin with water (perfumend water Nao Actal watr:L}
• • Demonstrate Checking Woter Tompetatule lAt Fasiolant Chosik wato Tonps
• Place Dignity Twel Over Resident -
• 11 Place Bed To Comfort Levd Verbelim whie holdin the remote to act raising bed
• 12 Put glover One at Time

~13+14 UNcover Resident, SAY

• I-5, Place ChUCKS wndew Buttoeks A Returw resident So pine Position Repent STeps 12+13 to
• -Other side Add Gust Chucks wider BUTTockS
• Make sure exposs only area Sarwunding catheter pulling blanker To Cavis knees
• Get Washclothes+ 1ST sask Wring SOOP PARTILYUNCOver Dignity Towal 1-pwards: EXPOCe resi dent peri aeca
• ~~"

Wash Clothes Haider
1st _washclothes And SOak. wring
(partly  Uncover Dignity Tawel 1-pwards  Expos,e Resident Peri aerea: -

Say Perform Will Wash genitalia Area Using Clean Side OF Wash Clooth sides font back Fano
 - faldx2 A middle frontsBack XI
- Discord The 1S+ washclothes In the Ham per - Cover THE Resident The Dignity Yowel
2 Get the 2nd - washclothes (Fan fald) A soaks Wring No Soap  say perfarm WII rinse the genitals  are 4 Sides Frant To BAcks FenfalX 4 muddle font Back  Discord I washclathts inthe Hamper 4 cover ResidentWithdignit Towel
- - [
- 20 say perform ON THE count OF 3 I will turn YOU to side please Haider to a side roll slowaly +Tum Susie BESTY on siebel
 -2 Remose chuCkA Dlspose in trash (Award Can famined

34 Empr WoshClean RiNse and Place
- 361Aem Ove gloves- And DLspos" in TRASH
 - 24 WothHonds Verbelire
 56 Cover Residents with Plaster"
- 41.51 Face Bed In sofer Low Love Verberis who Holds remote 10 act lowring Bed
- 4.342- UndoPriveiy
- 2.4-3 Place Coll light whitin Reach -
- 3.24) Wuth Hours (vetbolze;) DONE
- ~M-5)

### Skill 19 Feet
Knock -Wash
Yourself - Privacy
Ask them/Name band Explain
Draw and locate Items[**Leg,Clean, Clothe** [Clothes,Soap, Basix]**
All Items Ready-“BASIN -Get +Check Heat
Raise Level
UncoverLeg and Cover
Gloves - WIPE
- *SAY “Wipe and Clean**[**And In-Between’Toe**
- *SAY “Rinse and Repeat**
- *Say “Dry and IN_Between**
- *Then Apply lotion- EXCEPT BETWEEN Toe”. AGAIN.**
- *With towel- Get and Rub for EXCESS+ WIPE
Remove ALL and ALL done”**

### SKILL 20 - MOUTH Care
- [1] Knock!
- Two Wash!!!
- Three You +Four Privacy!
- Five and Sex. Name and what you do?
- [Seven] Collect ! Items 1, Basik, Soap Tooth, wash

- [8.] Check BASIK and HEAT
- [9]. RAISE the BED

- Ten. -Apply wash
- Liven Move
- (12) – Glove

- Toothpaste “Simulate
- (Wipe Simulate”
- State “ I shall wipe EVERY surface”!
-  Say. Show Tongue And “I shall gently wipe”
- Apply BASIN & Remove and Wash
- Wip and Dish

- RePosition and LOWBed-Re Privacy-Reach-Wash”

### SKILL 21 – Perineal CARE (PERI-CARE) FEMALE
- knock -wash hands -
- identify self -privacy,- ask for the client name
– explain for the Resident you perform PErintal care:
- Need :basin scap 
- 2,Towels (1 Dignity Towel & +  1 greyclean area towel)
- 6 WashClothes
- ChucksEquipment already placed on grey clean area towel and check  the hamper within your reach

- get basin with water (Parfum Woter. Na Actal Woter}
- Demonstrata Checking Mater Tramps lat Resident Chosik mate TrompsPlace- Dignity Twel Over Resident -
Place Bed To Comfort Levd Varbalize whito Hatden the remote atact taisin bod
Put glove Onat TIME

UNcover Resident, SAY 1-5 ,place ChUCKS ande Budder A retw resident So
- pine Position repeat STes 120+ , Other side Al Dyst Chucky wides ButtockS

~ Make sure exposs only area Surwanding catheter pulling blanker + Cover Knees

SAY perform will wash genitalia area 4 Sides Font To HAcks fone
fald X 4 mindd fads
Discord Washclatht inter Homper
Cover Resident digning yewel wash Clothes (Fan fald) 8 soaks Wring to Soap: say pertarmWill. Rinse the gendal, Area -I Sidas Frat Tobaoks Fa fal X to - mind Fads:Disciad 1Washcloth in the Hampers
 -Cover Residents with Dignit
 Tawel - 1054 Pertan or Cantt Of 3 will 10 side
 please Hatdal + Side Roll slowerly 4 Tuni Susie BeSty in sidibelRe Mose Chase Dispos"in trash Award Cane famined
Empr Wach Clam Rime
- Lams &Dis Pos"on TRASH
 WodhHonds Verbelize
Cover Resident with Phat
Fare Bed In sofer Low Love Vetbeis why Ho"des the remote To ael  loewring bed
- undoPriveey: Plac Cole lights
 - whit Wath Heure DONE