RETDEM SCRIPT: HANDWASHING AND GLOVING

Good morning, everyone, I am Darren Cadiente and I’m going to perform today my return
demonstration on medical handwashing and the donning and doffing of gloves through open
method.

HANDWASHING
For a brief rationale, hand hygiene is the single most effective precaution for prevention of
infection transmission between the patient and the healthcare staff.
Handwashing procedure starts with assessment, then the nursing diagnosis, followed by the
planning then implementation and the evaluation.
For the assessment, we begin the procedure by determining the need to perform the procedure
by utilizing the 5 moments of handwashing
First, Before touching the patient – this protects the patient from being infected with our germs
carried on our hands
Second, Before a clean or aseptic procedure -  this protects the patient from acquiring his or
her own germs from entering his/her body
Third, After a body fluid exposure risk – this protects us from being infected with the patient’s
germs and to protect the health care environment.
Fourth, After touching the patient – this protects us from acquiring patient’s germs and also to
protect the health care from germ spread
Lastly, After touching patients’ surroundings – this protects us from acquiring a patient's germs
that may be present from his/her surfaces or objects in its surroundings and to protect the
health care environment against it.
After utilizing the 5 moments of hand hygiene, the second assessment is to assess our hands.
Hand assessment begins by assessing our finger nails. Nails must be kept short – short nails
are less likely to have the presence of microorganisms, scratch our client or puncture gloves
during the procedure.
Next, Jewelries must be removed – microorganisms can indulge in the setting of jewelries and
under the rings. Removal of jewelries facilitates proper cleaning of the hands and arms.
Last, check for any skin injuries such as cuts, lacerations and abrasions – this must be done
because a nurse with an open wound may require to work in an area with a decreased risk for
contamination due to the chance of acquiring or passing on an infection.
For the nursing diagnosis, Risk for infection – improper handwashing will put the patient, the
healthcare environment and even the nurse at risk for infection and transmission of
microorganisms to one another.
For the planning process, we need to prepare all the materials needed for the procedure. This
includes an easy to reach sink with warm running water, antibacterial soap, dry paper towel and
an optional clean orangewood stick – Organizing these materials facilitate easy access during
the procedure.
For the implementation, first is to push the wristwatch and long uniform sleeves above the
wrists. Avoid wearing any jewelry. This provides complete access to our fingers, hands and
wrists. Wearing rings increases the number of microorganisms present in our hands.
Stand in front of the sink, with hands and uniform away from the sink surface. If hands touch
the sink surface, repeat the handwashing process. The sink is considered contaminated and
reaching over the sink increases the risk of touching the edge which is contaminated.
Avoid splashing water to our uniform – microorganisms can grow and travel in a moist
environment.
Next is to regulate the flow of water to ensure a warm temperature – warm water removes less
of protective oils on hands than hot water.
Wet our hands and wrist with running water thoroughly, keeping our hands and forearms lower
than the elbow – Hands are the most contaminated part to be washed. Water flows from least
to most contaminated areas, rinsing microorganisms to sink.
Apply a small amount of soap lathering thoroughly – The exclusive use of antiseptic may be
drying to the hands and cause skin irritations.
Rub our hands palm to palm – Friction and mechanically rubbing loosen and remove dirt and
transient bacteria.
Right palm over left dorsum with fingers interlaced and vice versa – Interlacing our fingers and
thumbs ensures that all surfaces are clean.
Next is palm to palm with fingers interlaced.
Then, the back of our fingers to opposing palms with fingers interlocked.
Followed by the rotational rubbing of the thumb clasped in our palm and vice versa.
Lastly, rotational rubbing backwards and forwards with clasped fingers of right hand in left palm
and vice versa
After that, rinse our hands and wrist with running water thoroughly, keeping hands down and
elbows up – rinsing mechanically washes away dirt and other microorganisms.
Then, Dry our hands thoroughly from fingers, to wrists to forearms with a paper towel. Discard
the towel after use in the receptacle – drying from the cleanest to least clean area avoids
contamination. Drying our hands prevents chapping and roughened skin.
Lastly, Turn off the faucet with a paper towel, keeping our hands uncontacted with the faucet
surface. Dispose the paper towel after use – wet towel and hands allow transfer of pathogens
from the faucet through capillary action.
For the last phase, the evaluation, Inspect our hand surface for any signs of dirt or other
contamination – this allows us to determine if our handwashing is adequate. And that wraps the
handwashing process. Thank you!

GLOVING USING OPEN METHOD

The second part of my return demonstration is the donning and doffing of gloves through an
open method. Gloves are worn during many procedures to enable the nurse to handle sterile
items freely and to prevent clients at risk for example those with open wounds from becoming
infected by microorganisms on unsterile gloves or the nurse’s hands.
Donning and doffing gloves also has five phases – assessment, diagnosis, planning,
implementation and the evaluation.
For the assessment part, I will first review the client’s record and orders to determine what
procedure will be performed that requires sterile gloves – this ensures that proper skill will be
implemented appropriately.
Next, I will check the client record and ask for latex allergies. If the patient has an allergy to
latex, I will use non-latex gloves when possible – identification of potential allergies helps to
prevent untoward incidents and also to protect the client and nurse.
For the diagnosis part, correct application of gloves helps to prevent contamination from
improper fit and protect the patient from latex allergies whenever possible.  
For planning, I will first think through the procedure, thinking what steps need to be done before
the gloves can be applied. I will determine what additional supplies may be needed in the
procedure and assure an extra pair of sterile gloves – this helps to avoid missteps and ensure a
smooth execution of the procedure.
Next, I will prepare all the necessary materials needed for the procedure. This includes a pack
of sterile gloves – well organized materials maintain efficiency in the procedure.
For the implementation phase, I will first ensure the sterility of the glove package – this is to
prevent no further contamination.
Prior to the procedure, I will introduce myself to the patient and verify my patient’s identity
through the agency protocol. I will explain to my patient what the procedure will be doing, why it
is important and how he/she can participate – this helps to alleviate a patient's anxiety and gain
cooperation and trust from them.
Then, I will perform a thorough hand hygiene – this to ensure that bacteria and microorganisms
are removed from skin surfaces and reduce transmission of it.
After performing the hand hygiene, I will provide my patient with privacy – this is to protect the
dignity of my client.
Then, remove the outer glove package by separating it and placing it in a clean, dry surface –
this allows the inner glove package to avoid being contaminated.
Next, I will grasp the inner package and lay it on a clean, dry surface above waist level. Open
the package, keeping the gloves inside the surface – the sterile object below the waist level is
contaminated. The inner surface of the glove is sterile.
Now, I will identify the right and left glove. After identifying, I will glove my dominant hand, which
is my right hand – proper identification of gloves prevents contamination by improper fit.
Gloving the dominant hand first improves dexterity.
With my thumb and two fingers of my non-dominant hand, I will grasp the edge of the cuff to
glove my dominant hand touching only the inside – this is due to the inner cuff edge lying to the
skin surface and therefore is not sterile.
Then, carefully pull the glove of my dominant hand, ensuring that my thumb and fingers are in
proper spaces – if the outer surface of the glove touches the hand or wrist, it is contaminated.
Then, with the gloved dominant hand, I will slip my fingers underneath the cuff of the other
glove – sterile touching sterile prevents glove contamination.
Next, I will carefully pull the second glove over the nondominant hand, not allowing my fingers
and thumb of the dominant hand to touch any part of the exposed nondominant hand, keeping
the thumb abducted back – contact of the gloved hand with the exposed hand results in
contamination.
After that, I will interlock my fingers of gloved hands and hold away from my body above waist
level until the procedure begins – this is to prevent accidental contamination from hand
movement.  
In removing gloves, I will grasp the outside of one cuff with the other gloved hand, avoiding the
wrist to touch. Pull the halfway down palm of the hand. Take the thumb of the half-ungloved
hand and place the cuff under the other glove – this minimizes the contamination of underlying
skin.
Then, I will pull the glove off, turning it inside out. Take the fingers of your bare hand and tuck
inside the remaining glove cuff. Peel the glove inside out and discard in the receptacle – the
outside of the glove does not touch the skin surface.
And lastly, for the evaluation process, conduct any follow-up indicated during the care of my
client. Ensure that adequate numbers and types of sterile supplies are available for the next
health care provider – this is to allow and maintain continuity of supplies.
And that wraps up my demonstration for both medical handwashing and the donning and
doffing of the gloves through an open method. Thank you everyone!