Name: ______________________________ Date: ___________________

Year/ Section ________________________ Score: __________________

Skill: HANDWASHING

Competency Rate:

3 – Excellent
2 – Satisfactory
1 – Need Practice

Preparation 3 2 1 Remarks
1. Determine:

a. Presence of factors increasing susceptibility to

infection and possibility of undiagnosed infection.
b. Whether the client uses immunosuppressive
medications
c. Recent diagnostic procedures or treatments that
penetrated the skin or a body cavity
d. Current nutritional status.
e. Signs and symptoms indicating the presence of an
infection:
Localized signs: swelling; redness; pain or tenderness
with palpation or movement; palpable heat at site,
loss of function of affected body part; or presence of
exudate.
Systemic indications: fever; increased pulse and
respiratory rates; lack of energy, anorexia; or enlarged
lymph nodes.
2. Determine:
a. The location of running water and soap or soap
substitutes
3. Assemble equipment:
a. Soap
b. Warm, running water
c. Disposable or sanitized towels
4. Assess the hands.
a. Nails should be kept short
b. Remove all jewelry
c. Check the hands for breaks in the skin, such as
hangnails or cuts
Procedure:

1. If you are washing your hands where the client can observe
you, explain to the client the purpose and importance of the
procedure.

2. Turn on the water, and adjust the flow.

There are five common types of faucet controls:

a. Hand-operated handles
b. Move knee levers with the knee regulate flow and
temperature
c. Press foot pedals with the foot to regulate flow and
temperature
 d. Move elbow controls with the elbows instead of the
hands
e. For infrared control, motion in front of the sensor
causes water to start and stop flowing automatically.

Be sure to adjust flow so that the water is warm.

3. Wet the hands thoroughly and rinse the hands.

a. Hold the hands lower than the elbows so that the

water flows from the arms to the fingertips.
b. If the soap is liquid, apply 2-4 ml (1tsp). if it is bar
soap, granules, or sheets, rub them firmly between
the hands.
4. Thoroughly wash and rinse the hands.

a. Use firm, rubbing, and circular movements to wash

the palm, back and wrist of each hand. Interlace the
fingers and thumbs, and move the hands back and
forth. Continue this motion for at least 15 seconds.
b. Rub the fingertips against the palm of the opposite
hand.
c. Rinse the hands.

5. Thoroughly dry the hands and arms.

a. Dry hands and arms thoroughly with a paper towel.

b. Discard the paper towel in the appropriate container.

6. Turn off the water

a. Use a new paper towel to grasp a hand-operated

control.

VARIATION: HAND WASHING BEFORE STERILE TECHNIQUE

Procedure:

a. Apply the soap and wash as described in step 4, But

hold the hands higher than the elbows under running
water, letting it run from fingertips to the elbows so
that the hands become cleaner than the elbows.
b. Apply the soap and wash as described earlier in step 6,
maintaining the hands uppermost.
c. After washing and rinsing, use a towel to dry one hand
thoroughly in a rotating motion from the fingers to the
elbow. Use a new towel to dry the other hand and
arm.

Prepared by:

NICA G. BALDICAÑAS RN, MAN

Clinical Instructor
Name: ______________________________ Date: ___________________
Year/ Section ________________________ Score: ________________

Skill: DONNING AND REMOVING STERILE GLOVES (OPEN METHOD)

Competency Rate:

3 – Excellent
2 – Satisfactory
1 – Need Practice

Preparation 3 2 1 Remarks
1. Check client record, and ask the client about latex allergies

2. Assemble equipment:
Packages of sterile gloves
3. Ensure sterility of the package of gloves
Procedure:
1. Introduce yourself, and verify the client’s identity. Explain to
the client the purpose and importance of the procedure and
how the client can cooperate.
2. Observe other appropriate infection control procedures.
3. Provide for client privacy
4. Open package of the sterile gloves.

a. Place the package of gloves on a clean, dry surface

b. If the gloves are packed in an inner as well as an outer
package, open the outer package without
contaminating the gloves or the inner package.
c. Remove the inner package from the outer package.
d. Open the inner package as in step 4 of the skill:
Establishing and Maintaining a sterile field, or
according to the manufacturer’s directions. If no tabs
are provided, pluck the flap so that the fingers do not
touch the inner surfaces.

5. Put the first glove on the dominant hand

a. If the gloves are packaged so that they lie side by side

gasp the glove for the dominant hand by its folded
cuff edge (on the palmar side) with the thumb and
first finger of the nondominant hand. Touch only the
inside of the cuff;
b. If gloves are packaged one on top of the other grasp
the cuff of the top glove as above, using the opposite
hand.
c. Insert the dominant hand into the glove and pull the
glove on. Keep the thumb of the inserted hand against
the palm of the hand during insertion.
d. Leave the cuff in place once the non-sterile hand
releases the glove.
6. Put the second glove on the dominant hand.

a. Pick up the other glove with the sterile gloved hand

inserting the gloved fingers under the cuff and holding
the gloved thumb close to the gloved palm.
b. Pull on the second glove carefully. Hold the thumb of
 the gloved first hand as far as possible from the palm.
c. Adjust each glove so that it fits smoothly, and carefully
pull the cuffs up by sliding the fingers under the cuffs.

7. Remove and dispose of used gloves

a. There is no special technique for the removing sterile

gloves. If they are soiled with secretions, remove them
by turning them inside out.
8. Document that sterile technique was used in the performance
of the procedure.

Prepared by:

NICA G. BALDICAÑAS RN, MAN

Clinical Instructor
Name: ______________________________ Date: ___________________
Year/ Section ________________________ Score: ________________

Skill: DONNING AND REMOVING PERSONAL PROTECTIVE EQUIPMENT

Competency Rate:

3 – Excellent
2 – Satisfactory
1 – Need Practice

Preparation 3 2 1 Remarks
1. Consider:
- Which activities will be required while you are in
client’s room to determine which PPE is required
- Arranging for the care of your other clients, if
necessary.
- If special handling is indicated for removal of any
specimens or other materials from the room.
- Which supplies are present within the client’s
room and which must be brought with you.

2. Assemble equipment and supplies:

= gown = mask
= eyewear = clean gloves
3. Remove or secure all loose items such as nametags or jewelry.
Procedure
1. Introduce yourself, and verify the client’s identity. Explain to
the client the purpose and importance of the procedure and
how the client can cooperate.
2. Perform hand hygiene
3. Don a clean gown:

a. Pick up the clean gown, and allow it to unfold in front

of you without allowing it to touch any area soiled
with body substances.
b. Slide the arms and the hands through the sleeves.
c. Fasten the ties at the neck to keep the gown in place.
d. Overlap the gown at the back as much as possible,
and fasten the waist ties or belt.

4. Don the facemask:

a. Locate the top edge of the mask. The mask usually has
a narrow metal strip along the edge.
b. Hold the mask by the top two strings or loops.
c. Place the upper edge of the mask over the bridge of
the nose, and tie the upper ties at the back of the
head or secure the loops around the ear. If glasses are
worn, fit the upper edge of the mask under the
glasses.
d. Secure the lower edge of the mask under the chin,
and ties at the nape of the neck.
e. If the mask has a metal strip, adjust this firmly over
the bridge of the nose.
f. Wear the mask only once, and do not wear any mask
longer than the manufacture recommends or once it
becomes wet.
g. Do not leave a used facemask hanging around the
neck.
5. Don protective eyewear if it is not combined with the
 facemask.
6. Don clean disposable gloves.
No special technique is required.

If you are wearing a gown, pull the gloves up to cover the cuffs
of the gown. If not wearing a gown, pull the gloves up to the
cover the wrist.

7. To removed PPE, remove the gloves first since they are the
most soiled.

a. If wearing a gown that is tied at the waist in front,

undo the ties before removing gloves.
b. Remove the first glove by grasping it on its palmar
surface just below the cuff, taking care to touch only
glove to glove.
c. Pull the first glove completely off by inverting or
rolling the glove inside out.
d. Continue to hold the inverted, removed glove by the
fingers of the bare hand inside the cuff of the second
glove.
e. Using the bare hand, continue to removes gloves
which are now inside-out, and dispose of them in the
refuse container.

8. Perform proper hand hygiene

9. Remove protective eyewear and dispose properly, or place in
the appropriate receptacle for cleaning.
10. Remove the gown when preparing to leave the room.

Unless a gown is grossly soiled with body substances, no

special precautions are needed to remove it. If a gown is
grossly soiled:

- Avoid touching soiled parts on the outside of the

gown if possible.
- Grasp the gown along the inside of the neck, and
pull down over the shoulders.
- Roll up the gown with the soiled part inside and
discard it in the appropriate container.

11. Remove the mask:

a. If using the mask with strings, first untie the lower

strings of the mask.
b. Untie the top strings and while holding the ties
securely, remove the mask from the face.

or if inside loops are present, lift the side loops up and

away from the ears and face

c. Discard disposable mask in the waste container.

d. Perform proper hand hygiene again.
Prepared by:

NICA G. BALDICAÑAS RN, MAN

Clinical Instructor
Name: ______________________________ Date: ___________________
Year/ Section ________________________ Score: ________________

Skill: DONNING AND REMOVING STERILE GLOVES (CLOSED METHOD)

Competency Rate:

3 – Excellent
2 – Satisfactory
1 – Need Practice

Preparation 3 2 1 Remarks
1. Check client record, and ask the client about latex allergies

2. Assemble equipment:
= sterile packs containing sterile gown
= sterile gloves
3. Insure sterility of the package of gloves
Procedure
1. Introduce yourself, and verify the client’s identity. Explain to
the client the purpose and importance of the procedure and
how the client can cooperate.
2. Observe other appropriate infection control procedures.
3. Provide for client privacy
Donning a sterile gown
4. Open the package of sterile gloves
Remove the outer wrap from the sterile gloves, and leave the
gloves in their inner sterile wrap on the sterile field
5. Unwrap the sterile gown pack
6. Perform hand hygiene
7. Put on the sterile gown:

a. Grasp the sterile gown at the crease near the neck,

hold it way from you, and permit it to unfold freely
without touching anything, including the uniform.
b. Put the hands inside the shoulders of the gown, and
work the arms partway into the sleeves without
touching the outside gown.
c. If donning sterile gloves using the closed method,
work the hands down the sleeves only to the proximal
edge of the cuffs
d. OR If donning sterile gloves by using the open method,
work the hands down the sleeves and through the
cuffs.
e. Have a coworker grasp the neck ties without touching
the outside of the gown, and pull the gown upward to
cove the neckline from the uniform in front and back.
The coworker ties the neck.
f. Have a coworker hold the waist tie of your gown,
using sterile gloves or a sterile forceps or drape.
g. Make a three quarter turn, then take the tie and
secure it in front of the gown; OR
h. Have a co-worker take the two ties at each side of the
gown, and tie them at the back of the gown, making
sure that the uniform is completely covered.
i. When worn, sterile gowns should be considered
sterile in front from the waist to the shoulder. The
sleeves should be considered sterile from 2 inches
above the elbow to the cuff since the arms of a
scrubbed person must move across a sterile field.

Donning sterile gloves

 8. Open the sterile wrapper containing the sterile gloves.
Open the sterile glove wrapper while the hands are still
covered by the sleeves
9. Put the glove on the nondominant hand
With the dominant hand, pick up the opposite glove with the
thumb and index fingers, handling it through the sleeve.
Lay the glove on the opposite gown cuff, thumb side down,
with the glove opening pointed toward the fingers. Position
the dominant hand palm upward inside the sleeve.
Use the nondominant hand to grasp the cuff of the glove
through the gown cuff and firmly anchor it.
Pull the sleeve up to draw the cuff over the wrist as you
extend the fingers of the nondominant hand into the glove’s
fingers.
10. Put the glove on the dominant hand.
Place the fingers on the gloved hand under the cuff of the
remaining glove.
Place the glove over the cuff of the second sleeve.
Extend the fingers into the glove as you pull the glove up over
the cuff.
Extend the fingers into the glove as you pull the glove up over
the cuff.
12. Remove and dispose of used gown and gloves.
There is no special technique for removing sterile attire. If
they are soiled, remove them by turning them inside out.
13. If appropriate, document that sterile technique was used in
the performance of the procedure.

Prepared by:

NICA G. BALDICAÑAS RN, MAN

Clinical Instructor

Name: ______________________________ Date: ___________________

Year/ Section ________________________ Score: ________________

Skill: GOWNING AND GLOVING TECHNIQUE,

 MAINTAINING A STERILE FIELD

OBJECTIVE: To prevent contamination to the surgical wound and help control infection via aseptic
principles.

STANDARD: Attention of surgical team to aseptic principles and standard precautions help ensure the
control of infection and microbial contamination by skin flora.

Competency Rate:

3 – Excellent
2 – Satisfactory
1 – Need Practice

3 2 1 Remarks
I. Gowning and Gloving:

GOWNING:

To don the gown, the scrub person:

a. Lifts the folded gown directly upward from the sterile

package.
b. Steps back from the table into an unobstructed area.
c. Carefully locates the neckband and holds the inside front
of the gown just below the neckband with both hands.
d. Let the gown unfold while keeping the inside of the gown
toward the body without touching the sterile exterior of
the gown with bare hands.

IF the gown does not unfold completely, then the circulating

nurse may assist by pulling down the unfolded bottom inside the
gown.
e. . Holds the hands at the shoulder level and slips both
arms into the armhole simultaneously.

GLOVING:

Closed Glove Technique - In the closed-glove technique, the scrub

person's hands remains inside the sleeves and should not touch
the cuffs. In the open-glove technique, the scrub person's hands
slide all the way through the sleeves out beyond the cuffs.

a. Keeps both hands within the cuff so that the hands do not
touch the cuff edges.
b. Grasps the folded cuff of the left glove with the right
hand.
c. Holds the top edge of the cuff in the left hand above the
palm.
d. Places the palm of the glove against the palm of the left
hand-the glove fingers point the forearm.
e. Grasps at the back of the cuff in the right hand and turn it
over the open end of the left sleeve and hand while
holding the top of the left glove and underlying gown
sleeve with the covered right hand.
f. Pulls tire glove over the extended left finger onto the
wrist by pushing the hand through the glove until it
completely covers the cuff of the glove.
g. Gloves the right hand in the same manner by reversing
the above steps.
h. Inspect the gloves for integrity after donning; and
i. Hands the tie end to the circulator and secures the wrap
around glove (when used).
Open Glove Technique - The closed glove technique should not
be used when changing one or both gloves because once the
hand has been passed through the cuffs, they are contaminated.
When a glove must be changed without assistance during a
surgical procedure, the open-glove technique is used.

Procedure

To change one glove during the procedure using the open-glove

technique, the scrub person:

a. Steps away from the sterile field.

b. Extends the contaminated glove away from the sterile
field so that the circulator, using exam gloves to protect
his/her hands, can remove it.
c. lifts the new sterile glove under the cuff with the
uncontaminated gloved hand.
d. Inserts the hand into the glove and pulls it on, leaving the
cuff turned well down over the hand and avoiding inward
rolling of the cuff. The bare hand does not touch the
outside of the glove.
e. Rotates the arm and pulls the cuff of the glove up and
over the sleeve cuff, letting the gloved fingers touch only
the outside of the other glove.

To change both gloves during a procedure using an open-glove

technique, the scrub Person:

a. Steps away from the sterile field.

b. Extends the contaminated glove away from the sterile
field so that the circulator, using exam gloves to protect
his/her hands, can remove it.
c. Picks up the left glove cuff, touching only the edge of the
cuff with his or her right thumb and index finger.
d. Pulls the glove onto the left hand and leaves the glove
cuff turned down.
e. Picks up the right glove with the gloved left hand, keeping
the gloved fingers under the folded cuff.
f. Slides the right hand fingers inside the right glove cuff and
pulls the glove onto the right hand while avoiding inward
rolling of the cuff.
g. Pulls the right glove cuff over the sleeve cuff by rotating
the arm.
h. Places the gloved right-hand fingers under the folded left
glove cuff, rotates the arm, and pulls the left glove cuff
over the sleeve cuff.

II. Assisted Gowning and Gloving

ASSISTING GOWNING- The scrub person may assist another

member in drying, gowning, and gloving by:

a. Opening the towel that the other member will use to dry
his/her hands.
b. Laying the towel on the team member's hand without
touching his/her hands.
c. Holding the gown at the neckband and carefully unfolding
 it.
d. Keeping the hands on the outside of the gown, forming a
protective cuff of the neck and shoulder area as the
person being gowned holds both hands outstretched.
e. Offering the inside of the gown to the other member so
he or she can slip his or her hands into the sleeves; and f.
Releasing the gown when the team members' hands are
in the sleeves.

ASSISTED GLOVING- To glove another team member, the scrub

person always gloves the other person's right hand first. The scrub
person:

a. Picks up the glove with his or her fingers under the cuff.
b. Holds the palm of the glove toward the person being
gloved.
c. Stretches the cuff to open the glove and holds his or her
thumbs out to keep them from touching the other team
member's bare hands.
d. As the other person inserts his or her hands into the
glove, exerts upward firm pressure making sure the hand
does not go below the waist.
e. Unfolds the inverted glove cuff over the cuff of the sleeve.
f. Gloves the left hand with the assistance of a team
member by repeating the steps.
g. Hold the tie as the other team member turns to secure
wraparound sterile gown when it is used.

ASSISTED RE-GLOVING- When a team member other than the

scrub nurse contaminates a glove during the surgical procedure,
the circulator, using exam gloves so that his hands are protected
will grasp the outside of the glove and pull it inside out. The scrub
person then re-gloves the team member as described above in
assisted gloving.

The options for the scrub nurse who needs to change gloves are
to: remove both gown and gloves, have another team member
assist in re-gloving, or use the open-glove technique.

The closed-glove technique cannot be use to re-glove.

In closed-gloving, the hand passes through the cuff of the gown
contaminating the edge of the cuff. This caused the glove to be
contaminated.

III. Removing Gown and Gloves

At the end of the procedure, the gown is always removed before

the gloves to prevent cross contamination of the wearer's scrub
attire. The circulator can assist by unfastening the neck and back
closures of the gown. The scrub person:

a. grasps the shoulders of the gown, pulls it downward from

the shoulder and off the arms, and turns the sleeves
inside out.
 b. folds the contaminates surface of the gown on the inside
and rolls it away from the body.
c. Discards the rolled gown in the appropriate receptacle.

As the gown comes off it usually turns the cuffs of the gloves
down. To removes the gloves the wearer uses a glove-to-glove
and then a skin-to-skin technique. This approach protects hands
from the contaminated glove. The scrub person:

a. Grasps the under cuff of the left glove with the gloved
fingers on the right and pulls it off inside out.
b. Slips the ungloved fingers of the left hand inside the right
glove and slips it off inside out.
c. Discards the gloves in the appropriate receptacle.
d. Washes hands and arms with soap and water.

Removing the gloves after removing the gown prevents

the bare hands from contamination that would usually
occur from handling the soiled gown.

IV. Maintaining a Sterile Field:

The surgical team should take precautions to avoid contamination

and maintain the sterile field. The hands should be kept above the
waist and insight at all times.

THE STERILE AREAS ARE:

a. The front of the gown from the table level or sterile field
to two inches below the neck.
b. The sleeves from two inches above the elbow to the cuff.
c. The surgical gloves.

The underarms are considered nonsterile.

The back of the gown is not considered sterile even if it
is the wraparound style.
If any part of the sterile attire becomes contaminated,
immediate corrective steps must be taken (e.g. if a glove
becomes contaminated, it must be changed
immediately).
Once the original gloves are donned, the gown cuffs
should be considered contaminated because the
scrubbed hand passed through them.

Prepared by:

NICA G. BALDICAÑAS RN, MAN

Clinical Instructor