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Medical Colleges of Northern Philippines
Medical Colleges of Northern Philippines
Medical Colleges of Northern Philippines
PERFORMANCE CHECKLIST
Name:
__________________________________________
Date:_________
Section:________________
STERILE GLOVING
Performe
d
S
US
PROCEDURE
Assessment
1. Verify that procedure requires sterile
gloves
2. Check for latex allergy/sensitivity
3. Inspect condition of the hand
Preparation
4. Assemble equipment and supplies
Sterile Gloves
5. Remove or secure all loose items such as
hand jewelry
6. Check integrity of glove package
7. Introduce yourself, and verify the clients
identity. Explain to the client what you
are going to do, why it is necessary, and
how the client can cooperate
8. Perform hand hygiene
Procedure
9. Remove outer package wrapper using
sterile technique
10.
Open inner wrapper
11.
Identify right and left gloves
12.
Glove dominant hand first, touching
only inside of glove
13.
With gloved hand, slide fingers
under cuff of glove for nondominant
hand. Pull glove onto nondominant hand
without touching exposed skin, keeping
thumb of dominant hand abducted back
14.
Interlock fingers of gloved hands,
holding hands away from body
15.
Proceed with intended procedure
Glove removal
16.
Grasp outside one cuff with gloved
hand and pull off, turning glove inside
out. Discard glove.
17.
Remove remaining glove by placing
fingers of bare hand under cuff and pull
off, turning glove inside out. Discard
glove.
18.
Discard
gloves
in
the
waste
container
19.
Perform hand hygiene
TOTAL SCORE
NOT
PERFOR
MED
Comments
PERFORMANCE CHECKLIST
_________________________________
Evaluator