Kingdom of Saudi Arabia

Ministry of Health
General Directorate of Health Affairs- Aseer Region
Prince Faisal bin Khalid Cardiac Center

NURSING COMPETENCY CHECKLIST

BASIC ASEPTIC TECHNIQUE

Competency Statement:
The nurse shall observe all appropriate measures to halt or mitigate the spread of infectious agent among patients and their
environment.

Mandatory Learning Resources:

 Review the Policy on Aseptic Technique, Standard Precaution and Hand Hygiene.
 Attend In-service Orientation on Basic Aseptic Technique.

Score
No. Performance Criteria/Evidence Methodology
1 2 3
1. Demonstrate knowledge on the Chain of Infection. □ VE □ DO □ WE □ RD
2. Define Basic Aseptic technique and its importance in patient safety. □ VE □ DO □ WE □ RD
3. Demonstrate knowledge about Standard Precaution. □ VE □ DO □ WE □ RD
4. Demonstrate knowledge and skills in Hand Hygiene:
 Enumerate the 5-moments of hand hygiene.
□ VE □ DO □ WE □ RD
 Perform Alcohol-based handrub
 Perform soap and water handwash
5. Demonstrated knowledge and skills in DONNING personal protective □ VE □ DO □ WE □ RD
equipment.
6. Demonstrated knowledge and skills in DOFFING personal protective □ VE □ DO □ WE □ RD
equipment
7. Demonstrate knowledge about cough etiquette. □ VE □ DO □ WE □ RD
8. Demonstrate knowledge and skills on the proper disposal of wastes
materials:
8.1. Used needles and syringes □ VE □ DO □ WE □ RD
8.2. Body-fluid contaminated items □ VE □ DO □ WE □ RD
8.3. Blood □ VE □ DO □ WE □ RD
8.4. Pharmaceutical wastes □ VE □ DO □ WE □ RD
8.5. Diagnostic samples □ VE □ DO □ WE □ RD
9. Demonstrate knowledge and skills in assisting sterile procedures
9.1. Verified integrity and expiration date of sterile supplies. □ VE □ DO □ WE □ RD
9.2. Demonstrate knowledge and ability to handle soiled linens. □ VE □ DO □ WE □ RD
9.3. Demonstrate knowledge and ability to clean the procedural / □ VE □ DO □ WE □ RD
dressing trolley prior to procedure.
9.4. Demonstrate knowledge and ability to open the sterile pack □ VE □ DO □ WE □ RD
without contamination.
9.5. Demonstrate pouring of sterile solution. □ VE □ DO □ WE □ RD
9.6. Demonstrate correct technique of opening and putting on sterile □ VE □ DO □ WE □ RD
glove.
9.7. Demonstrate knowledge and ability to perform cleaning of □ VE □ DO □ WE □ RD
reusable medical equipment.

Methodology: VE: Verbal Exam DO: Direct Observation WE: Written Exam RD: Return Demonstration
Scoring System:
 Novice (1 point)- when a need to teach the staff nurse of the general rule on how to perform a task is established.
 Competent (2 points)- when a perspective to perform a task with efficiency is exhibited.
 Expert (3 points)- when performances are fluid, flexible, and highly-proficient.
 Kingdom of Saudi Arabia
Ministry of Health
General Directorate of Health Affairs- Aseer Region
Prince Faisal bin Khalid Cardiac Center

NURSING COMPETENCY CHECKLIST

BASIC ASEPTIC TECHNIQUE

9.8. Demonstrated knowledge and ability to perform appropriate

disposal of used supplies:
□ VE □ DO □ WE □ RD
□ Yellow bag
□ Sharps container □ Black / Blue bag
9.9. Identify sterilization indicator of medical items. □ VE □ DO □ WE □ RD
10. Demonstrate knowledge and skills in managing needle-stick injury. □ VE □ DO □ WE □ RD
Total Score /66

REMARKS:

Assessor’s Evaluation: □ Independent □ Supervision Required □ Dependent (for re-evaluation)

Assessor’s Name/Employee No.: ________________________ Signature: __________ Date: ____________

Employee Name/Employee No.: ________________________ Signature: __________ Date: ____________

Legend:
INDEPENDENT : Scores above 90%
SUPERVISION REQUIRED : Scores 80%-89%
DEPENDENT : Scores below 80%

Methodology: VE: Verbal Exam DO: Direct Observation WE: Written Exam RD: Return Demonstration
Scoring System:
 Novice (1 point)- when a need to teach the staff nurse of the general rule on how to perform a task is established.
 Competent (2 points)- when a perspective to perform a task with efficiency is exhibited.
 Expert (3 points)- when performances are fluid, flexible, and highly-proficient.