Sterile Asepsis Grading Rubric
Student: ______________________ Tester: ___________________
Procedure: Simple Dressing Female Cath.
Scan room
Scan ID
Preparation:
O Check physician’s order and check agency policy
O Gather supplies
O Introduce self
O Provide privacy
O Explain procedure and obtain consent
O Hand hygiene
Implementation: Catheterization:
O Ensure bed at appropriate height / side rails
up on opposite side, set up table facing away
from patient
O Don clean gloves and prepare patient:
position patient, place waterproof pad, drape
with sheet, perform pericare, visualize area,
assess for need for assistance and/or light.
O Remove gloves. Wash hands.
O Sets up garbage bag according to principles
O Attach drainage bag to bed and close clamp
O Opens sterile tray according to principles
O Adds supplies according to principles
O Dons sterile gloves and prepare tray: loosen
cap on specimen container, removed
catheter from plastic wrap, apply lubrication
for female 2.5-5 cm, for male 12.5-17 cm,
attach syringe to appropriate port, add
betadine to cotton balls, place drape and
fenestrated drape
O Move sterile tray to between patient’s legs
O Cleanse urethra according to principles
O Insert catheter until urine flows, then
advance additional 2.5 cm, for female 5-7.5
cm, for male 17-22.5 cm
O Insert sterile water for balloon inflation
O Attach drainage bag recognizing need to
keep port and end of drainage bag sterile
O Removes gloves according to principles
O Discards dirty/soiled equipment according to
principles
O Prepares client & environment (post
procedure): call bell in place, brakes
Revised Feb 5, 2021
Male Cath.
Implementation: Wound Dressing
O Ensure bed at appropriate height / side rails
up on opposite side, set up table facing
patient so dominant hand is closest to
patient
O Remove dressing tray from package and
prepare garbage bag
O Don clean gloves for outer dressing removal
and dispose of gloves
O Open sterile dressing tray according to
principles
O Add supplies and pour cleansing solution
according to principles
O Use transfer forceps to remove inner
dressing
O Assess drainage (type, amount) and wound
O Don sterile gloves and arrange tray
O Position sterile drape
O Cleanse and dry wound according to
principles
O Apply dressing
O Remove sterile gloves and tape dressing
O Discard soiled equipment according to
principles
O Prepare client and environment (call bell in
place, brakes engaged on bed, bed in
lowest position etc.)
O Documentation including time, assessment,
intervention, tolerance of patient
 engaged on bed, bed in lowest position etc.
O Documentation of time, catheter size, type,
amount of solution to inflate balloon and
tolerance of patient

Critical Thinking:

O Maintain principles of surgical asepsis

O Recognize when sterile principals compromised
O Able to problem solve if sterile field contaminated
O Identify appropriate alternate solutions

More than 3 instances of identified contamination will be considered a fail

Comments/Recommendations:

Outcome:
P = Pass F = Fail

Revised Feb 5, 2021