UNIVERSITY OF ST.

LA SALLE
College of Nursing
NCM 112 – Intraoperative Checklist
Skills Lab.
Able to Able to Needs Remarks
Perform Perform w/ Improvement
PROCEDURES
Assistance

3 2 1
Prewash
1. Perform handwashing with antimicrobial soap. Using a paper
towel, pat dry from finger tips until elbow in a circular manner.
One arm at a time.
Surgical Hand Hygiene with Alcohol Based Hand Rub
2. Put approximately 5 ml (3 doses) of alcohol-based hand rub in
the palm of your left hand. Use your elbow to operate the
dispenser.
3. Dip the fingertips of your right hand in the hand rub for 5 seconds
4. Smear the hand rub on the right forearm up to 2 inches above
the elbow. Ensure that the whole skin area is covered by using
circular movements around the forearm until the hand rub has
fully evaporated (10-15 sec). Repeat steps 2 to 4 on the other
arm.
5. Put approximately 5 ml (3 doses) of alcohol-based hand rub in
the palm of your left hand using your elbow to operate the
dispenser
6. Cover the whole surface of the hands including the wrists with
alcohol-based hand rub, rubbing palm against palm with a
rotating movement. (20-30 secs)
7. Rub palm against palm, back and forth with fingers interlinked.
8. Rub the back of the left hand with back and forth movement. And
vice versa.
9. Rub the back of the fingers by holding them in the palm of the
other hand with a sideways back and forth movement. And vice
versa
10. Rub the thumb of the left hand by rotating it in the clasped palm
of the right hand. And vice versa.
11. Air dry hands. DO NOT SHAKE.
Gowning and Gloving
12. Reach down to the sterile field and grasp the gown at the crease
near the neck. Step back and allow the hem of the gown to drop,
do not allow it to touch anything unsterile.
13. While holding the folded gown, carefully locate the neckline and
the armholes. With the gown raised at the shoulder level, slip
both arms into the armholes.
14. Extend both arms into the armholes simultaneously as the gown
and sleeves unfold. Do not allow your hands to be exposed
outside the cuff.
15. Maintain at least 1 foot away from the sterile table and the front
of the gown. Wait for the circulating nurse to tie your back.
Perform Closed-gloving Technique

16. With hands still inside the gown sleeves, open the sterile glove
wrapper on the sterile field.
17. With your non-dominant sleeved hand, grasp the cuff of the
glove for your dominant hand.
18. Lay the glove on the extended dominant palm, thumb side down
with the glove opening pointed towards the fingers.
19. Use the non-dominant hand to grasp the cuff of the glove, unfold
it and wriggle the fingers in.
20. With the dominant hand working through its sleeves, grasp the
upper side of the glove’s cuff and stretch it over the cuff of the
gown.
21. Pull the sleeve up to draw the cuff over the wrist as you extend
the fingers of your dominant hand inside the glove’s fingers.
22. With the gloved dominant hand, repeat the procedure for the
non-dominant hand.
23. Be sure that the entire cuff of each sleeve is contained within the
sterile glove.
Removing of Gown and Gloves

24. Grasp the front of the gown at the shoulders below the neckline
and pull it off forward inside out and rolled off away from the
body. Discard the contaminated gown in the hamper.

25. By using glove to glove, skin to skin technique, remove the soiled
gloves and discard it properly.
TOTAL = 75