ILOILO DOCTORS’ COLLEGE

COLLEGE OF NURSING
West Avenue, Molo, Iloilo City

DONNING STERILE GOWN AND CLOSED GLOVING

PERFORMANCE CHECKLIST
Student’s Name: ______________________________Score/ Equivalent: ________________
Year & Sec: _________________________________Date Performed: __________________

PERFORMANCE RATING:
5- Consistently demonstrate high level performance.
4- Achieves performance standards above average.
3- Satisfactorily achieves performance standards.
2- Performs task with difficulty.
1. Performance is below expected standard

PROCEDURE 5 4 3 2 1
1. Don surgical attire and scrub your arms and hands as described.
2. Have the circulating nurse or other designated person open the sterile gown
and gloves.
3. Don Gown
4. Pick up and unfold the gown.
5. Identify the inner surface of the gown and pick up the gown beneath the
neckband without touching the sterile field or other surface of the gown.
6. Make sure you have control of all the folded layers to avoid dangling the gown
against the unsterile surfaces.
7. Move away from the tablet, holding the gown away from your body at arm’s
length, holding the gown away from your body at arm’s length and allow it to
unfold from the top down. Do not let the gown touch the floor.
8. Hold the gown just below the neckband near the shoulders and slide both
hands into the sleeves until the fingers are at the end of the cuffs but not
through the cuffs. The fingers remained covered to prepare for the closed
gloving.
9. Have someone tie the gown
10. Put on the gloves.
11. Apply the first glove.
12. With your hands covered by the sterile gown cuffs. The first glove goes on the
dominant hand
13. Position the glove on the forearm so the cuff faces the hand and the fingers
face the elbow.
14. Begin to put the opposite hand into the glover with the sleeve cover of the
hand to be gloved.
15. Grasp the back of the glove cuff with the sleeve-covered second hand and turn
the cuff over the sleeve.
16. Push your fingers into the glove.
17. Apply the second glove.
18. Use your sterile hand to pick up the second glove. Put the second glove in the
same position as the first on the opposite forearm.
19. Put on the second glove in the same manner as the first.
20. Adjust the gloves for fit and comfort.
TOTAL
Student’s Signature : _________________
Instructor’s Signature: __________________

Verified by:

CYGNETTE S. LUMBO, R.N., Ph. D. MA. ANA V. CRUZ, R.N., M.A.N.

Academic Coordinator, IDC-CON Clinical, Coordinator, IDC-CON

Approved:

MA. JOSEPHINE B. PROVIDO, R.N., PH. D.

Dean, IDC- CON