What is the correct diaper-changing process?

As described in the Notes for Clarification for Item #9 in the ITERS-R, Diapering/toileting, the diapering process is as follows. Staff should prepare for a diaper change before bringing the child to the diapering area by having ready:

• Changing table paper (if used) to cover the table for the child's shoulders to the child's heels ( in case it becomes soiled and must be folded over to give a clean surface during the change)
• Enough wipes for the diaper change (including wiping child's bottom and adult's hands after taking the soiled diaper away from the child's skin)
• A clean diaper and plastic bag for soiled clothes and clean clothes if soiled clothing is anticipated
• Non-porous gloves (if used)
• A dab of diaper cream on a disposable piece of paper or tissue (if used)

Supplies should be removed from their containers before starting the diaper change. Once supplies are readied, the child is brought to the changing table. After the soiled diaper is removed and placed in a hands-free covered trash can (usually one that has a step pedal that lifts the lid) and any soiled clothes are removed and placed in a tied or sealed bag, the child's and caregiver's hands are then wiped with a disposable diaper wipe. Once the clean diaper is put on and clothes refastened (or changed if necessary), the child's hands are thoroughly washed with liquid soap and warm running water for at least 10 seconds (time to sing "Row, Row, Row Your Boat"). Any toys or other objects that are handled during a diaper change must be put aside to be sanitized. The diaper surface should then be sanitized by spraying with a bleach and water solution (¼ cup of bleach to 1 gallon of water) and allowing the surface to air dry for up to 2 minutes. While the changing surface is drying the adult should thoroughly wash hands with liquid soap and warm running water for at least 10 seconds. The diaper surface can then be wiped or, preferably, left to air-dry until the next change.