URDANETA CITY College of Health Sciences

UNIVERSITY
Owned and operated by the City Government of Urdaneta
Bachelor of Science in Nursing

CHECKLIST ON HANDWASHING

Name: ___________________________________ Date: ____________________

Year and Block: ____________________________ RLE Group: ________________

Able to
Unable
Able to Perform
PROCEDURE to
Perform with
Perform
Assistance
MEDICAL TECHNIQUE:      
ASSESSMENT      
1. Inspect hands for visible soiling, breaks or cuts in the
skin and cuticles.
PLANNING      
2. Assemble all the equipment.
IMPLEMENTATION
3. Roll your sleeves above your elbows, and remove your
watch and all other wrist jewelry. Do not touch the
sink.
4. Turn on the water, adjust to appropriate temperature      
and leave it running during the procedure.
5. Wet your hands and forearms well under the running
water and maintain the level of your hands lower than
elbows. Avoid splashing.
6. Lather your hands, wrists, and forearms with liquid or
bar soap.
7. Wash hands, wrists, and forearms thoroughly using
firm circular motion and friction on back of the hands,
palms, and wrists. Wash each finger individually paying
special attention to areas between fingers and
knuckles by interlacing fingers and thumbs moving
hands back and forth. Re lather if necessary.
8. Clean fingernails carefully using a nail file or other    
nail-cleaning utensil.
9. Rinse thoroughly your hands, wrists, and forearms
starting from one elbow moving down to the hand,
then repeat it to the other arm.
10. Dry your hands thoroughly starting from fingertips,
hand, wrist and forearm using clean dry hand towel or
paper towel.
11. Use another clean towel or paper towel to turn off the
faucet.
12. Use hand lotion if desired.
EVALUATION
13. Evaluate the condition of your hands whether you
have disinfected all surfaces.

SURGICAL TECHNIQUE:
1. Inspect hands for cuts in the skin and cuticles. Do not
scrub if there are open wound such as lesions or
breaks in the skin.
2. Remove rings, chipped nail polish, and watch then roll
the sleeves above the elbow.
3. Put on cap or hood, shoe cover and a mask
4. Use a deep sink with side foot pedal.
5. Turn on water using foot or knee control and adjust
temperature to be comfortably warm.
6. Wet hands starting from the tip of fingers to forearms
keeping hands higher than elbows.
7. Apply soap to a scrub brush or open a pre-packaged
scrub brush if available.
8. With brush on your dominant hand, using a circular
motion, scrub nails and all skin areas of non-dominant
hand and arm (ten strokes to each of the areas).
 URDANETA CITY College of Health Sciences
UNIVERSITY
Owned and operated by the City Government of Urdaneta
Bachelor of Science in Nursing
9. Take second scrub brush and repeat actions in no. 8
on your dominant hand and arm.
10. Keep the hands and forearms above elbow level,
place the fingertips under running water and
thoroughly rinse the fingers, hands the forearms.
11. Keep arms flexed and proceed to operating room
12. Secure a sterile towel by grasping it on one edge,
opening it full length, making sure it does not touch
your uniform.
13. Dry each hand separately, and extend one side of the
towel around fingers and hands and dry in a rotating
motion up to the elbow.
14. Reverse towel and repeat same action on the other
hand and arm, thoroughly drying the skin. Discard
towel into linen hamper.
Final  
Grade:

Remarks:

______________________________________________________________________________
______________________________________________________________________________
_______________________________________________________________
  
Rating Scale:

Excellent: 96-100% Good: 80-84%

Very Satisfactory: 90-95% Fair: 75-79%
Very Good: 85-89% Poor: 74% and below

______________________________ ______________________________
Clinical Instructor Student’s Signature