PAMANTASAN NG LUNGSOD NG MAYNILA

COLLEGE OF NURSING

Medical- Surgical Nursing 1

SKILLS LABORATORY CHECKLIST

Procedure: DONNING STERILE GOWN

(for surgical procedure)

Name: _______________________________________ _Date:______________________________

Year Level and Block:_______________________ Clinical Instructor:________________
Rating scale:
3 Performed correctly, systematically according to standard with correct rationale.
2 Performed correctly, with correct rationale but not systematic.
1 Performed correctly, but not systematic and with inadequate rationale.

0 Performed incorrectly.

Procedure
1. Do surgical scrubbing (surgical
handwashing) prior to entering the
OR/ theater.
2. Once at the OR, dry hands with
sterile towel (following the steps sited
at the surgical handwashing checklist)
3. The circulating nurse standing at the
opposite side of the table will assist
the scrub nurse in opening the
wrapper of the sterile gown.
- The circulating nurse should only
be touching the folds of the
wrapper.
- After the wrap was opened the
circulating nurse moves back away
from the area, then the scrub
nurse approach the table.
Performance Remarks
Rationale
3 2 1 0
- To remove debris and transient
microorganisms from the nails,
hands and forearms,
- Reduce the resident microbial
count to a minimum, and
- To inhibit rapid rebound growth
of microorganisms
*Bacteria frow better in moist
areas
Drying wet hands is important to
keep out bacteria &
contamination at bay on your
hands
Circulating nurse ensures that
operating rooms and other sterile
personnel are sterilized and that
they remain sterile during
procedures. Therefore, they work
only at the non-sterile field and at
least 1 foot away from the sterile
areas or to any sterile personnel.

Picking up the Gown

4. With one hand, pick up the entire
folded gown from the wrapper by
grasping the gown through all layers,
being careful to touch only the inside
top layer which is exposed.
Maintains sterility of the gown
and position it for donning. Edges
of anything that encloses sterile
contents are considered unsterile.
 5. Once your hands are securely
pinching the gown. Hold the gown
near the gown's neck and
allow it to unfold.
6. Step back from the shelf and allow
the gown to drop. Make sure the
gown does not touch any surrounding
unsterile objects.
4. Grasp the inside shoulder seams
and open the gown with the armholes
facing you.
Inserting your arms into the sleeves of the gown
5. Carefully insert your arms part way
into the gown one at a time, keeping
hands at shoulder level away from the
body.
6. Slide the arms further into the gown
sleeves and when the fingertips are level
with the proximal edge of the cuff, grasp
the inside seam at the cuff hem using
thumb and index finger. Be careful that
no part of the hand protrudes from the
sleeve cuff.
Fastening the gown
7. A theatre assistant/ circulating nurse
will fasten the gown behind you,
positioning it over the shoulders by
grasping the inside surface of the gown
at the shoulder seam. The theatre
assistant’s hands should only ever be in
contact with the inside surface of the
gown.
8. The theatre assistant/ circulating
nurse then prepares to secure the gown
at the neck and upper back. Gowns
differ in how they are secured, but most
with have either ties, buttons or Velcro
tabs.
9. The circulating person then ties the
gown at waist level at the back.
Note: before the final tie of the gown the
scrub nurse must first perform the sterile
close gloving procedure.
To avoid contaminating outer
surface, ungloved hands can only
touch the exposed layer of the
gown.
Be careful and do not let the gown
touch anything unsterile as it
drops.
Proper identification of the
armholes provide a smooth and
easy access of inserting the gown.
Keep hands inside the cuffs to
prevent contamination and a
preparation for closed gloving.
Shrug your arms into the sleeves
while keeping your hands
wrapped into the cuffs until you
get your gloves.
Prevents any part of the gown
from touching a non-sterile object
provides complete coverage of
undergarments.
This adheres to the sterile-sterile,
unsterile-unsterile movements,
and to avoid contaminating the
front of the gown that is already
considered sterile.
Gowns of the surgical team are
considered sterile in front from
the chest to the level of the sterile
field
 Final tie of the gown
10. The scrub person will take hold of
the belt tab which is securing the belt
ties. Keeping hold of the left side tie with
the left hand pull the tab with the right-
hand ties still secured and hand the tab
to the circulating person.
Variation: in the absence of the belt tab,
the scrub nurse may use a sterile forceps
to hold the tip of the belt. The forceps
will then be handed to the circulating
nurse. The circulating nurse must only
hold on to the forceps, careful not to
touch any part of the tie.
11. The circulating person will take hold
of the tab/ forceps being very careful
not to touch the tie and will move to the
side or behind the scrub person. The
scrub person will then turn, if necessary,
to enable them to reach and retrieve the
tie.
12. When the scrub person is properly
positioned they will then take hold of
the belt tie only being careful not to
touch the tab or forceps and pull on the
tie leaving the circulating person with
only the tab/ forceps in their hand The
circulating person must hold on tightly
to the tab/ or release clamp of the
forceps so that when the scrub person
pulls on the tie the tab/ forceps doesn't
come with it and contaminate them.
13. Finally the scrub practitioner will
secure the ties on left side.
Evaluated By:
________________________________
Signature over Printed Name
Clinical Instructor
Secure the closure of the gown by
assisting the circulating nurse in
handling the tab while still
preventing contact with them.
Circulating nurse should only
come contact with unsterile items
and areas. Contact with unsterile
surgical team could contaminate
gown and gloves. Gown must
enclose undergarments.
Unsterile personnel keep in
contact with unsterile items and
areas only. They also must be
knowledgeable on the proximity
to the sterile field and personnel
to avoid contamination.
Sterile OR personnel come in
direct contact with persons who
wears gowns and gloves only.
The items that they will touch are
sterile equipment. Any supply
brought by an unsterile staff
should transfer the item in a
sterile manner.
Securing the ties properly
provides complete coverage of
undergarments from being
exposed.
________________________________
Signature over Printed Name of Student