Aseptic Technique Checklist

This checklist has been designed for use with any aseptic procedure and can be used to assess medical and nursing staff. Points marked
with * apply to medical procedures such as long line insertion and are therefore not applicable to procedures such as preparing PN for
infusion.

Criteria Achieved (Yes 3, No X, NA) Comments

Shaded cells not achieved =
automatic fail
1. Chooses appropriate trolley and ensures it is
thoroughly cleaned and allowed to dry.
2. Washes hands and forearms using the 6-stage
technique. Dries with STERILE towel.
3. Aseptic application of alcohol gel using elbow or
assistant.
4. Gown put on without contamination (*)
5a.Gloves put on aseptically without contamination.
b. Including second pair for medical procedures (*)
6. Equipment prepared with assistant (packets
opened away from the sterile field) without
contamination
7. Assistant opens incubator port holes & cleans
them with alcohol wipes.
8. Area cleaned appropriately and allowed to dry
without contamination of sterile field/gloves. Eg.
Arm in long line placement, hub in LL access
9. Top layer of gloves removed (*)
10. Appropriately completes the procedure without
contamination of the sterile field, equipment or gown
& gloves.
11. Appropriately changes equipment, gloves or
gown if contamination occurs.
12. Safe removal of sharps.

Please see overleaf for information regarding DOPS grading.

For use with Direct Observation of Practice (DOPS)

Aseptic technique is graded during a DOPS from 1-6 (see table). This is normally in relation to the level of training. However, aseptic
technique is an important part of clinical care and needs to be performed to a high level regardless of level of training. All staff have
received training on aseptic technique on commencement of this placement. We therefore recommend the following scoring system to
equate with above.

DOPS Grading Scale
1 Unsafe
2 Below expectations
3 Borderline
4 Meets expectations
5 Above expectations
6 Well above expectations
Aseptic Technique Checklist & Guidance for DOPS Grading
Demonstrates no, or very little, understanding of the principles of aseptic technique. Does not appear
to have used the Infection control working package. One or more automatic fails.
Fails to achieve aseptic technique or needs prompting. One automatic fail.
Needs prompting at any stage to ensure aseptic technique is maintained.
Performs procedures without prompting. All relevant criteria achieved.
All relevant criteria achieved. Demonstrates knowledge and understanding of aseptic technique.
Directs assistant and uses them appropriately.
Completes all of the relevant criteria to a high level and demonstrates an excellent understanding of
aseptic technique.