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    Scrubbing Gloving Checklist

    Uploaded by

    Lea Celestial
    The document contains two performance checklists for surgical hand scrubbing and donning/removing sterile gloves. The hand scrubbing checklist has 26 steps that are rated on a scale of 1 to 5. The glove checklist has 20 steps also rated on a scale of 1 to 5. Both checklists assess skills, mastery of procedures, use of proper technique, and receptiveness to feedback. The student and instructor sign off on the evaluation with overall performance comprising 70% of the grade.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Scrubbing Gloving Checklist

    Uploaded by

    Lea Celestial
    83 views3 pages
    The document contains two performance checklists for surgical hand scrubbing and donning/removing sterile gloves. The hand scrubbing checklist has 26 steps that are rated on a scale of 1 to 5. The glove checklist has 20 steps also rated on a scale of 1 to 5. Both checklists assess skills, mastery of procedures, use of proper technique, and receptiveness to feedback. The student and instructor sign off on the evaluation with overall performance comprising 70% of the grade.

    Original Title

    SCRUBBING-GLOVING-CHECKLIST

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    © © All Rights Reserved

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    The document contains two performance checklists for surgical hand scrubbing and donning/removing sterile gloves. The hand scrubbing checklist has 26 steps that are rated on a scale of 1 to 5. The glove checklist has 20 steps also rated on a scale of 1 to 5. Both checklists assess skills, mastery of procedures, use of proper technique, and receptiveness to feedback. The student and instructor sign off on the evaluation with overall performance comprising 70% of the grade.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    83 views3 pages

    Scrubbing Gloving Checklist

    Uploaded by

    Lea Celestial
    The document contains two performance checklists for surgical hand scrubbing and donning/removing sterile gloves. The hand scrubbing checklist has 26 steps that are rated on a scale of 1 to 5. The glove checklist has 20 steps also rated on a scale of 1 to 5. Both checklists assess skills, mastery of procedures, use of proper technique, and receptiveness to feedback. The student and instructor sign off on the evaluation with overall performance comprising 70% of the grade.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    SAN PEDRO COLLEGE

    Davao City

    PERFORMANCE CHECKLIST
    SURGICAL HANDSCRUBBING

    Name: _______________________________________ Grade: ___________


    Year and Section: ______________________________ Date: ____________

    Legend: 5 – Excellent 4 - Very Good 3 - Good 2 – Fair 1 – Poor


    Rating 5 4 3 2 1
    1. Checks for completeness of supply.
    2. Removes all pieces of jewelry, including the wedding
    ring.
    3. Trims nails if needed. Removes nail polish or artificial
    nails.
    4. Wears surgical cap and disposable mask.
    5. Stands before the sink keeping the body away from it.

    6. Turns on the faucet and adjusts the pressure using the foot,
    knee or elbow control.
    7. Holds hands above elbow, wets the skin from the
    fingertips down to the elbow.
    8. Wets and applies approximately 1 tsp of antimicrobial
    soap on the palm using foot, knee or elbow control and
    works up a lather.
    9. Using a pre-packaged scrub brush-sponge pad, opens the
    package, removes the nail cleaner and cleans the nails and
    discard.
    10. Removes the brush and discards the wrapper without
    putting down the brush.
    11. Moistens the brush or sponge and dispense the soap into it.
    12. Using the brush, makes 20 circular strokes on the nails
    (starting with the less dominant hand).
    13. Scrubs all skin surfaces using circular strokes:
    a. each finger
    b. palm
    c. back of the hand
    d. forearms (divide into 2 then 10 strokes on each
    of the 4 parts of the first half of the forearm then
    another 10 strokes on each 4 parts of the second
    half of the forearm paying extra attention on the
    elbow)
    14. After scrubbing the less dominant hand, rinses the brush
    and transfers it to the other hand.
    15. Continues the procedure on the dominant hand following
    steps 11 to 13.
    16. When the scrub is finished on the dominant hand, drops the
    brush on the sink.
    17. With the use of foot, knee or elbow control, turns on the
    faucet and rinses the arms starting from the fingertips to
    the elbow.
    18. Turns off the water using the foot, knee or elbow control.
    19. Positions the hands and elbow above the waist without
    touching any part of the scrub uniform.
    20. Enters the operating room using the back or the buttocks.
    21. Maintains body mechanics throughout the performance of
    the procedure.
    22. Manifests neatness in the performed procedure.
    23. Receptive to criticisms.
    24. Observes courtesy.
    25. Shows calmness while performing the procedure.
    26. Uses correct English.

    27. Shows mastery of the procedure.


    SAN PEDRO COLLEGE
    Davao City

    PERFORMANCE CHECKLIST
    DONNING AND REMOVING STERILE GLOVES
    Name:__________________________________ Grade: ___________________
    Year and Sec.: _________________ Date : ___________________
    Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor
    Rating
    5 4 3 2 1
    1. Washes hands.
    2. Selects appropriate size of gloves.
    3. Prepares adequate work area at waist height.
    4. Opens wrapper correctly.
    5. Places gloves with cuff end toward the body.
    6. Grasps first glove touching inside only.
    7. Turns to side of sterile field and pulls glove.
    8. Lifts second glove by slipping gloved fingers under cuff.
    9. Turns to side of sterile field and pulls glove on.
    10. Unrolls cuff touching only outside of glove.
    11. After use, removes gloves by turning them inside out
    without touching outside surface with bare hands.
    12. Drops used gloves onto wrapper.
    13. Rolls gloves in wrapper and disposes them properly.
    14. Maintains body mechanics throughout the
    performance of the procedures.
    15. Manifests neatness in the performed procedure.
    16. Receptive to criticisms.
    17. Observes courtesy.
    18. Shows calmness while performing the procedure.
    19. Uses correct English.
    20. Shows mastery of the procedure.
    Remarks:

    Criteria : I Knowledge (quiz) 30%


    II Performance 70%
    100%
    ________________________________ __________________________
    Student’s Signature Over Printed Name Date
    ________________________________ __________________________
    Instructor’s Signature Over Printed Name Date

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