Republic of the Philippines

CAVITE STATE UNIVERSITY

(CvSU)
DON SEVERINO DE LAS ALAS CAMPUS
Indang, Cavite
415-0010 loc 270/200 862-0806
www.cvsu.edu.ph

COLLEGE OF NURSING

FUNDAMENTALS OF NURSING – NURS 04

RELATED LEARNING EXPERIENCE
Name:_____________________________ Date: _______________
Year and Section: _________ Group No. __________

Competency Performance Checklist

Medical Handwashing

Very Good Fair Needs

PROCEDURE Good Improveme
4 3 2 nt
1
Assessment
1. Assess the hands for visible soiling, breaks
or cuts in the skin and cuticles.
Planning
2. Assemble the equipment.
Implementation
3. Remove jewelry and watch and push long
sleeves above elbows. Don’t allow the
uniform to touch the sink.
4. Adjust the water to appropriate temperature
and flow
5. Wet elbow and hands under running water
always keeping hands lower than the
elbow.
6. Lather hands with liquid soap or if bar soap is
used wash soap and lather hands.
7. Return bar soap on the soap dish without
touching the dish.

8. Performed hand hygiene for about 20

seconds using plenty of friction and lather.
a. Rubbed palms using firm circular motion.

b. Right palm over left dorsum with

interlaced fingers and vice versa.

c. Palm to palm with fingers interlaced.

d. Backs of fingers to opposing palms with

fingers interlocked.
 e. Rotational rubbing of left thumb and each
finger individually paying attention
to areas between fingers and knuckles
and then vice versa.

f. Rub the fingertips against the palm

of the opposite hand and vice versa.

9. Rub and wash the wrist above 1 -2

inches moving forward and
backward. .
10.Clean fingernails carefully under running
water using an orange stick.

11. Rinse elbow down to hands completely,

keeping hands lower than elbows.

12. Dry hands thoroughly with towel starting

from the fingertips, hands and then wrist
and forearm.
13. Turn off faucets with a hand towel or
tissue paper

14. Used hand lotion if desired.

Evaluation
15. Inspect hands and nails for cleanliness.
Documentation
16. Record time when hand washing is done

Perfect Score: 88
Passing Score: 62
Total Score:

Remarks:
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____________________________ __________________________________
Student’s Name and Signature Clinical Instructor’s Name and Signature

CON SKILLS LAB FORM - 001