CHECKLIST FOR MEDICAL HANDWASHING

Instructions to student

At this station you are required to do and record the procedure

Observations Marks Participants

1. Introduces self 1
2. Preparation /Arrangement of articles 2
3. Inspection of hands(cuts,lesions,wounds) 2.5
4. . Remove jewelry/ring .bracelet/wrist watch and roll up 2.5
long uniform sleeve above wrist watch .
5. Stand in front of the sink, keeping hands and uniform 2.5
away from sink surfaces.
6. Turn on water. Avoid splashing water against uniform, 2
Regulate the flow of water and make sure that the water
is warm.

7. Wet hands and wrist thoroughly under running 3.5

water.Keep hands and forearms lower than elbows
during washing.
8. Apply small amount of soap /antiseptic liquid 2
wash,lathering thoroughly.
9. Wash hands using plenty of lather and friction for atleast 3
10 to 15 seconds.Interlace fingers and rub palms and
back of hands with circular motions for atleast 5 times
each.
10. Ensure that finger nails should be clean.Rinse wrist and 2.
hands thoroughlykeeping hands down and elbows up.
11. Turn off water and dry hands thoroughly from fingers to 1
wrist and to forearm with paper towel and
12. Discard used towel 0.5
13. Replacement of articles 0.5

TOTAL 25

REMARKS

SIGNATURE OF SUPERVISOR SIGNATURE OF STUDENT

 CHECKLIST FOR SURGICAL HANDWASHING
Instructions to student

At this station you are required to do and record the procedure

Observations Marks Participants

1. Introduces self 0.5

2. Preparation /Arrangement of articles 1
3. Inspection of hands(cuts,lesions,wounds) 2
4. . Remove jewelry/ring .bracelet/wrist watch /nailpolish . 1
5. After medical handwash,wear cap and mask. Turn on 1
water with elbow
6. Wet hands and arms under running water and lather with 2.5
soap wash to 5cm above the elbows.
.
7. Ensure to use firm circular movements to wash 4
palms ,back of hands,wrist,forearms and interdigital
spaces for 20 -25 seconds
8. Rinse hands and arms thoroughly under running water 2.5
and ensure to keep hands above elbows
9. Clean under nails of both hands with nail brush 2
Scrub nails of each hand with 15 strokes using
antimicrobial agent.
10. Holding the brush perpendicular scrub palm ,each side of 2
thumb and fingers and posterior side of hand with 10
strokes each.
11. Scrub from wrist to 5cm above each elbow that is lower 2.5
arm,upper arm and antecubital fossa to marginal area
above.
12. Maintain the duration of scrubbing for 5 to 10 minutes 1
13. Rinse hands from fingertips to elbows and take care not 1
to touch the tap or sides of the sink during the procedure

14 Use a sterile towel to dry one hand moving from fingers 1

to elbow and dry from cleanest to least clean area. Use
one side to dry one hand and reverse side for other
hand ,if only one towel is available.
15 Discard towel. 1

TOTAL 25

REMARKS

SIGNATURE OF SUPERVISOR SIGNATURE OF STUDENT

 CHECKLIST FOR MASKING AND GOWNING
Instructions to student

At this station you are required to do and record the procedure

SL.N OBSERVATIONS Marks

O
1 MASKING 1
Preparation of articles
2 Perform surgical handwashing 2
3 Take the sterile mask handed over to you by 2
circulating nurseand hold it by top two
strings,keeping top edge above bridge of nose.
4 Tie both top strings at back of head above ears . 1
5 Tie the two lower strings snugly around neck 2
well under the chin.
6 Gently pinch the upper portion of mask around 2
bridge of nose
GOWNING
1. Grasp the sterile gown at the crease near the 0.5
neck,hold it away from yourself
2 Hold the gown at the shoulder level from inside 1
and put each hand directly into the armhole.
3 Extend the arms and hold hand upward at 1.5
shoulder level while putting through the
armhole.
4 The circulating nurse pulls back the gown from 1
inside. The circulating nurse ties the gown from
the back.
5 Loosen the waist ties by the scrub nurse and the 1
flap is around the waist .
TOTAL MARKS 15

REMARKS

SIGNATURE OF SUPERVISOR SIGNATURE OF STUDENT

 CHECKLIST FOR SURGICAL GLOVING
Instructions to student

At this station you are required to do and record the procedure

Observations Marks Participants

1. Introduces self 0.5

2. Preparation /Arrangement of articles 0.5
3. Perform thorough surgical handwash and dry hands 1
using sterile towel
.
.

4. The circulating nurse removes the outer glove package by 1

carefully separating and peeling apart the sides.Scrubbed
nurse pulls out the inner glove pack
5. Grasp the inner package and lay it on clean,flat surface 1
just above the waist level .Open package keeping gloves
on wrapper’s inside surface
6. If gloves are not prepowdered ,take packet of powder 1
and apply lighly to hands over sink or waste basket
Identify the right and left glove.Each glove has a cuff of
approximately 5cm wide.Glove the dominant hand first.

7. With thumb and first two fingers of non dominant 2

hand ,grasp the edge of cuff of glove dominant
hand.Touch only the inside surface of gloves.

8. Pull glove over dominant hand making sure the thumb 1

and fingers fit into the proper spaces of the glove

9. Slip in the fingers of the gloved dominant hand under 1

the cuff off the other glove.
Keep thumb of gloved dominant hand abducted back to
avoid touching of exposed non gloved hand
10. Carefully slip the glove onto your non dominant hand 1
making sure that finger slip into proper spaces.
With gloved hands ,interlock fingers to fit the gloves onto
each fingers.

TOTAL 10

REMARKS

SIGNATURE OF SUPERVISOR SIGNATURE OF STUDENT