URDANETA CITY College of Health Sciences

UNIVERSITY
Owned and operated by the City Government of Urdaneta
Bachelor of Science in Nursing

CHECKLIST ON APPLYING A STERILE GOWN AND PERFORMING CLOSED

GLOVING WITH RATIONALE

Name: ___________________________________ Date: ____________________

Year and Block: ____________________________ RLE Group: ________________

Able to
Unable
Able to Perform
PROCEDURE to
Perform with
Perform
Assistance
STEPS      
APPLYING STERILE GOWN
1. Before entering operating room or treatment area,      
apply cap, face mask, eye wear and foot covers
(paper or cloth covers fit over work shoes).
2. Perform thorough surgical hand wash.      
3. Circulating nurse assist by opening the pack containing
the sterile gown (folded inside out).
4. Circulating nurse prepares glove package by peeling      
outer wrapper open while keeping inner contents
sterile. Places inner glove package on sterile field
created by sterile outer wrapper.
5. Reach down to sterile gown package; lift folded gown
directly upward and step back away from table.
6. Holding folded gown, locate neckband. With both
hands grasp inside front of gown just below
neckband.
7. Allow gown to unfold, keeping inside gown toward
body. Do not touch outside of gown with bare hands.
8. With hands at shoulder level. Slip both hands into
armholes simultaneously. Ask circulating nurse to
bring gown over your shoulders by reaching inside to
arm seams and pulling gown on, leaving sleeves
covering hands.
9. Have circulating nurse securely tie back of gown at
neck and waist (if gown is wraparound style, do not
touch sterile flap to cover it until you are gloved)

PERFORMING CLOSED GLOVING

a. With hands covered by gown sleeves, open inner

sterile glove package
b. With dominant hand inside gown cuff, pick up glove
by non- dominant hand by grasping folded cuff.
c. Extend non-dominant forearm with palm up and place
palm of glove against palm of non-dominant hand.
Glove fingers point toward elbow.
d. Grasp back of glove cuff with covered dominant hand
and turn glove cuff over end of non-dominant hand
and gown cuff.
e. Grasp top of glove and underlying gown sleeve with
covered dominant hand. Carefully extend fingers into
glove, being sure that glove cuff covers gown cuff.
f. Glove dominant hand in same manner, reversing
hands. Use gloved non-dominant hand to pull on
glove. Keep hand inside sleeve.
g. Be sure that fingers are fully extended into both
gloves.
10. For wraparound sterile gown: take gloved hand and
release fastener or ties in front of gown.
11. Hand paper tab connected to sterile tie to circulating
nurse, who is non sterile. Circulating nurse stands still
as you turn completely around to left, allowing for
margin of safety as gown wraps around and covers
your back. Take back sterile tie from circulating nurse
and secure tie to gown.
OPEN GLOVING
 URDANETA CITY College of Health Sciences
UNIVERSITY
Owned and operated by the City Government of Urdaneta
Bachelor of Science in Nursing
1. Perform thorough hand hygiene.

2.Remove outer glove package wrapper by carefully

separating and peeling apart sides.
3. Grasp inner package and lay it on clean, flat surface
just above waist level. Open package, keeping gloves
on wrappers inside surface
4. Identify right and left glove. Each glove has a cuff
approximately 5cm (2 inches) wide. Glove dominant
hand first.
5. With thumb and first two fingers of non-dominant
hand, grasp edge of cuff of glove for dominant hand.
Touch only inside surface of glove.
6. Carefully pull glove over dominant hand, leaving cuff
and being sure that it does not roll up wrist. Be sure
that thumb and fingers are in proper spaces.
7. With gloved dominant hand, slip fingers underneath
cuff of second glove.
8. Carefully pull second glove over non-dominant hand.
Do not allow fingers and thumb of gloved dominant
hand to touch any part of exposed non dominant
hand. Keep thumb of dominant hand abducted back.
9. After second glove is on, interlock fingers of gloved
hands and hold away from body above waist level
until beginning procedure
GLOVE DISPOSAL

10. Grasp outside of one cuff with other gloved hand;

avoid touching wrist. Pull halfway down palm of hand.
Take thumb of half-ungloved hand and place under
cuff of other glove.
11. Pull glove off, turning it inside out. Discard in
receptacle.
12. Take fingers of bare hand and tuck inside remaining
glove cuff. Peel glove off, inside out. Discard in
receptacle.
Final  
Grade:

Remarks:

______________________________________________________________________________
______________________________________________________________________________
_______________________________________________________________
  
Rating Scale:

Excellent: 96-100% Good: 80-84%

Very Satisfactory: 90-95% Fair: 75-79%
Very Good: 85-89% Poor: 74% and below

______________________________ ______________________________
Clinical Instructor Student’s Signature