Far Eastern University

Institute of Health Sciences and Nursing

PERFORMANCE EVALUATION TOOL FOR

MEDICAL HAND WASHING

NAME: __________________________________________________ DATE: ______________ SCORE: _______________

SEC & GRP NO: ________________ CONCEPT: ______________________ FACULTY: __________________________

Direction: Rate the learners based on the competencies listed below.

RATING SCALE QUANTITATIVE DESCRIPTION

3 ACCEPTABLE Demonstrates expected procedures / behaviors correctly
2 MODERATELY ACCEPTABLE Demonstrates expected procedure/behavior with minimal error
1 SLIGHTLY ACCEPTABLE Demonstrates expected procedure/behavior with many error
0 UNACCEPTABLE Missed procedure or procedure done but entirely incorrect

NURSE AS PRACTITIONER RATING REMARKS

Practice nursing in accordance with existing laws, legal, ethical and moral principle
Communicate effectively in writing, speaking, and presenting using culturally appropriate language.
Adopt the nursing core values in the delivery of nursing care.
Perform safe, appropriate, and holistic care to individuals, families, population groups, and communities
utilizing the nursing process
Demonstrate the core values of FEU (Fortitude, Excellence, and Uprightness) in the practice of the nursing
profession
A. PREPARATION 0 1 2 3
1. If appropriate, introduced self and verified client’s identity.
2. Informed client of the procedure and its importance 0 1 2 3
3. Assembles all the articles needed and brings to bedside 0 1 2 3
B. PROCEDURE
4. Turned on water and adjusted the flow so the water was warm. 0 1 2 3
5. Wets the hands thoroughly by holding them under running water, and
applies soap to the hands. If the soap is liquid, apply 2-4 ml (1 tsp). If it is
0 1 2 3
a bar soap, granules, or sheet, rubs them firmly between the hands and
rinses them
6. Holds the hands lower than the elbows so that the water flows from the
0 1 2 3
arms to the fingertips
7. Washes and rinses the hands thoroughly 0 1 2 3
8. Following the steps below:
a. Rub hands palm to palm; 0 1 2 3
b. Rub back of each hand with palm of other hand with fingers interlaced; 0 1 2 3
/revised as of June 2015/
Name: ____________________________ Medical Handwashing Page | 2

c. Rub palm to palm with fingers interlaced; 0 1 2 3

d. Rub with back of fingers to opposing palms with fingers interlocked; 0 1 2 3
e. Rub each thumb clasped in opposite hand using a rotational movement; 0 1 2 3
f. Rub tips of fingers in opposite palm in a circular motion; 0 1 2 3
g. Rub each wrist with opposite hand; 0 1 2 3
9. Rinses hand with running water letting it run from wrist to fingertips 0 1 2 3

RATING REMARKS
10. Dries hand and arms thoroughly with a paper towel 0 1 2 3
11. Discards the paper towel in appropriate receptacle 0 1 2 3
12. Turns off the water using a new paper towel to grasp a hand operated
control faucet 0 1 2 3
C. AFTER CARE
13. Disposes supplies and materials used accordingly 0 1 2 3

Procedure

Total Score ÷ 57 X 100 = _______

______________________________________ _________________________________________
Signature of Student Signature of Faculty

/revised as of August 2022/