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JOSE RIZAL UNIVERSITY

College of Nursing and Health Sciences

Performance Checklist
Medical Handwashing

Name of Student: ___________________________ Date: ___________

Year/Section/Group No.: ________________ Grade: __________

Rate the student’s performance by checking the appropriate box using the following criteria:

5- Excellent (Carries out procedure efficiently and systematically)

4- Very Satisfactory (Carries out procedure efficiently or systematically, requires minimal guidance and supervision)
3- Satisfactory (Carries out procedure efficiently or systematically, requires moderate guidance and supervision)
2- Fair (Carries out procedure with close guidance and supervision)
1- Poor (Unable to perform the procedure)

A. KNOWLEDGE – 30% 5 4 3 2 1
1. Determine:
 Presence in client of factors increasing susceptibility to
infection.
 Whether client uses immunosuppressive
 Client’s medications
 Recent diagnostic procedures or treatments that
penetrated the client’s skin or a body cavity.
 Signs and symptoms indicating the presence of an
infection:
2. Determine:
 The location of running water and soap or soap
substitutes.

3. Assemble equipment:

 Soap

 Warm, running water

 Disposable or sanitized towels

4. Assess the hands:

 Nails should be kept short

 Remove all jewelry

 Check hands for breaks in the skin, such as hangnails

or cuts
B. SKILLS - 60%
1. If you are washing your hands where the client can observe you,
explain to the client what you are going to do and why it is necessary.
2. Turn on the water, and adjust the flow.

 For knee levers, move with the knee to regulate flow

and temperature.
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 For foot pedals, press with the foot to regulate flow

and temperature.
 For elbow controls, move with the elbows instead of
the hands.
 For infrared control, motion in front of the sensor,
causes water to start and stop flowing automatically.
(Be sure to adjust flow so that water is warm)
3. Wet the hands thoroughly by holding them under the running water,
and apply soap to the hands.
 Hold the hands lower than the elbows, so that the
water flows from the arms to the fingertips
 If the soap is liquid, apply 4-5ml (1tsp.). If it is a bar
soap, granules or sheets, rub them firmly between the
hands.
4. Thoroughly wash and rinse the hands
 Right palm over the left dorsum with interlaced fingers
and vice versa
 Palm to palm with fingers interlaced
 Back of fingers to opposing palms with fingers
interlocked.
 Rotational rubbing of the left thumb closed in right
palm and vice versa
5. Thoroughly pat dry the hands and arms
 Dry hands and arms thoroughly with a paper towel,
wiping from fingertips toward forearm without
scrubbing
 Discard the paper towel in the appropriate container.
6. Turn off the water
 Use a new paper towel to grasp a hand-operated
control.
C. ATTITUDE – 10%
1. Shows responsibility by having a complete set of equipment needed
in the activity and shows interest in doing the procedure
2. Displays courtesy and consideration in acknowledging criticisms and
suggestions by the clinical instructor
3. Demonstrates integrity by doing the skill honestly, competently and
completely
TOTAL

A. Knowledge - Total score / Total no of items x 60 + 40 = _____x .3= _____

B. Skills - Total score / Total no of items x 60 + 40 = _____x .6= _____

C. Attitude - Total score / Total no of items x 60 + 40 = _____x .1= _____

Total grade = _____

Clinical Instructor’s Comments / Suggestions:

______________________________________________________________________________________________
_________________________________________________.

Students’ Comments / Suggestions:

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______________________________________________________________________________________________
_________________________________________________.

___________________________ _________________________

Student’s name & signature C.I.’s name & signature