PERFORMANCE CHECKLIST SKILL 29-1 HAND HYGIENE

Student:_____________________________________________________Date:_________________
Instructor:___________________________________________________Date:_________________

Total Points Earned ______ / Total Possible Points (36) = SCORE ______________

2=Performed Correctly 1=Performed Incorrectly 0=Did not Perform

____________________________________________________________________________________________________

2 1 0 Comments

1. Inspected hands for breaks in skin and

cuticles, reacted appropriately to any lesions
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found.

2. Inspected hands for visible soiling.

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3. Inspected condition of nails, ensured nails

were properly kept.
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4. Adjusted sleeves and wristwatch
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appropriately. Did not wear rings.

5. Washed properly with antiseptic hand rub:

a. Applied proper
amount of product to D D D points

palm of one hand.

b. Rubbed hands

together, covered all

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surfaces of hands
and fingers with
antiseptic.

c. Rubbed hands until

dry, allowed hands to D D D points

dry before applying

gloves.

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6. Washed properly using antiseptic
soap:
a. Stood in front of sink.
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Kept hands and
uniform away from
sink surface.

b. Turned water on with

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pedals.

c. Avoided splashing
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water against uniform.

d. Regulated water flow

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for warm temperature.

e. Wet hands and wrists

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thoroughly, kept hands
and forearms lower
than elbows.

f. Applied proper D D D points

amount of soap,
lathered thoroughly.

g. Ensured cleanliness of D D D points

fingernails.

h. Rinsed thoroughly,
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points
kept hands lower than

elbows.

i. Dried hand
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appropriately.

j. Discarded paper towel

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properly if used.

k. Turned water off _______points

D D D
without

contaminating hands

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