UPHSL/DJGTMU-ACAD

06-02-014-00

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA

UNIVERSITY OF PERPETUAL HELP-DR. JOSE G. TAMAYO MEDICAL UNIVERSITY

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Student's Name: _____________________________
Section/Group No. ___________________

PERFORMANCE CHECKLIST IN HANDWASHING

PERFORMANCE POINTS 4 3 2
ASSESSMENT
Inspects hands for breaks / cuts in the skin or cuticles.
1 Report and covers affected part, if possible.
care.
2 Inspects hands for heavy soiling / dirt, and nails for length.
PLANNING
Prepares the following :
a. soap and soap dish d. tissue paper
3
b. orange stick e. lotion (optional)
c. towel
IMPLEMENTATION

4 Rolls uniform sleeves above elbow. Wristwatch and

rings should be removed prior to handwashing.

5 Stands in front of sink, keeping hands and uniform away

from sink surface.

6 Turns on water by turning faucet on or using knee/foot

control to regulate water flow and temperature.
7 Be careful not to splash water into uniform.
8 Wets hands and elbow thoroughly under running water.
9 Hands and forearms should be lowered during washing.
10 Applies a small amount of antiseptic. Lather thoroughly.

Builds lather and uses plenty of friction for minimum of

11 10-15 secs. Interlace fingers. Rubs palms and dorsum
back of hands using circular motion at least 5x for each
hand.
12 Keeps fingertips down.

13 Uses both hands to clean fingernails using additional

soap and orange stick.

14 Rinses hands and wrists thoroughly, keeping elbows up

and hands down.
 15 Makes a lather starting from the elbow, applies soap in
rotating motion.
16 Rinses thoroughly, keeping hands lower than elbows.
Uses paper towel, single use towel or warm dryer to dry
17 hands. Dries hands thoroughly from fingers to wrists
and forearms.
18 Discards soiled paper towel properly.
19 Turns off water
Uses clean, dry flow using
paper foot
towel to or knee
turn pedals.
off hand faucet.
20 Avoid touching it with bare hand.
Applies a small amount of lotion or barrier cream if
21 hands are dry or chapped.
22 After care of equipment/environment
88/

STUDENT'S SIGNATURE: _________________________________

CLINICAL INSTRUCTOR'S SIGNATURE: ______________________
4/11/2020
 UPHSL/DJGTMU-ACAD -RDC-10B
06-02-014-00

NIVERSITY

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 UPHSL/DJGTMU-ACAD -RDC-1
06-02-2014-00

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA

UNIVERSITY OF PERPETUAL HELP-DR. JOSE G. TAMAYO MEDICAL UNIVERSITY
COLLEGE OF NURSING

Student's Name: _____________________________

Rating
Section/Group No. ___________________

RETURN DEMO CHECKLIST LEVEL 2

I. SURGICAL HANDWASHING
4 3 2
Assesses the Assessment
environment for equipment and
1 cleanliness.
2 Assesses oneself for preparedness/capabilities
Planning
3 Hands and forearms will be adequately cleansed
before wearing sterile gloves and gown.
Implementation
Preparation
4 Have
Removes jewelry and
two surgical chipped
scrub nailand
brushes polish.
nail file
5 available.
6 Applies mask and cap approprately.
7 Applies surgical shoe-cover.
Surgical Handwashing
8 Applies
At the sink,
soapwets
andforearms and
rub hands hands
and armsunder warm fl
2 inches
9 above elbows.
10 Cleans underneath each nail of both hands and
drop file onto the sink.
Scrubs nails and all areas of nondominant hand
11 and arm with soap,scrub brush in dominant hand
using circular motion.
12 Rinses brush thoroughly, reapplies soap.
Continues with scrub of nondimant arm. Drops
13
brush into the sink.
With second scrub brush, does the same with the
14
dominant hand and arm. (repeat step 11-13)
15 Rinses fingers, hands and arms thoroughly.
16
Keeps arms flexed and proceed to the sterile field.
TOTAL /48 =
 STUDENT'S SIGNATURE: _________________________________
CLINICAL INSTRUCTOR'S SIGNATURE: ______________________
4/10/2020
 UPHSL/DJGTMU-ACAD -RDC-10B
06-02-2014-00

UNIVERSITY

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1 Comments