MOTHER THERESA POST GRADUATE AND RESEARCH

INSTITUTE OF HEALTH SCIENCES

COLLEGE OF NURSING
(Govt of Puducherry)
Indira Nagar, Gorimedu, Puducherry-605006
CHECKLIST FOR EVALUATION OF STUDENTS PERFORMANCE DURING
HAND WASHING PROCEDURE
Department Of Community Health Nursing

Participant number: ___________________________ Date: _________________

Skill station:

Observation: observes if the participants is performing the following steps of bag technique in
the correct sequence and techniques.
Score: ‘1’ for each point conducted correctly and ‘0’ for if the task is not done as recommended.

SL. STEPS OF PROCEDURE SCORE1/0 REMARKS

NO
1. Place the community bag on the newspaper, over the
clean/sterile side
2. Remove the wrist watch and ornaments in the hands

3. Unbutton the top outer lining and take the hand wash
articles from the outer pouch and keep it over small plastic
sheet at washing area.
4. Select a dry place where water will drain off.
5. Scrub the hands with soap and water to work up a good
lather for 40-60 secs.
 Rub palm to palm
 Rub the back of both hands
 Interface fingers and rub hands together
 Interlock fingers and rub the back of both hands
 Rub thumb in a rotating manner followed by the
area between index finger and thumb for both hands.
 Rub fingertips on palm for both hands.

7. Scrub 2-3 minutes with nail brush if any surgical procedure

or wound dressing to be conducted.
 8. Wash the hands from hands to elbows thoroughly
9. Dry the hands using hand towel and place it on the clean
place.
10. Touch the inner part of the upper compartment and remove
the required articles for the procedure.
11. After the procedure wash hands again and dry with towel.

12. Replace the articles, close the bag.

13. Replace the hand washing articles after drying under the sun

Pass score: 11
Student score: _______
Pass: Yes/No

Recommendation: Satisfactory ______ Unsatisfactory ______

Unsatisfactory (Must document how the student was unsatisfactory on the reverse side of this
form)

Student: Date:

Instructor: _______________________ Date: