PROCEDURE CHECKLIST GOWNING WITH CLOSED GLOVING

NAME: ____________________________________________
SCORE:__________________________
COURSE/YR. /SEC.:___________________________________ DATE:
___________________________

Legend: Done Student performs consistently in an effective & efficient manner

Not Done No progress in performance has been demonstrated &/ or

Performance is consistentlyineffective and inefficient

Not
PROCEDURE Done REMARKS
Done
PUTTING ON GOWN
1. Observe the placement of various sterile fields.
Approach the mayo stand with gown and gloves opened
upon it. Keep your body away from the sterile field.
Reach from above down to the gown
2. Reach directly onto the gown. Avoid touching the
glove package or gown wrapping. “Pinch” the gown,
controlling all layers
3. Lift the gown vertically from the Mayo stand. Keep
your body away from the Mayo stand.
4. Once the gown is lifted from the sterile field, step back
from the Mayo stand. Beware of other sterile fields & do
not back into them
5. Put on the sterile gown. Identify the collar of the
gown. Inside of the gown facing toward you
a. Grasp the sterile gown at the crease near the
neck, hold it away from you and permit it to
unfold freely without touching anything
including the uniform
b. Put the hands inside the shoulders of the gown
and work the arms partway into the sleeves
without touching the outside of the gown
c. Work the hands down the sleeves only to the
proximal edge of the cuffs. Be careful the fingers
will not be out of the sleeves cuff
d. Have the circulating nurse grasp the neck ties
without touching the outside of the gown and
pull the gown upward to cover the neckline of
your uniform in front and back. The circulating
nurse ties the neck ties.
e. Swing your body so that your circulating nurse
can grasp the tie same with the other side ties
at the back.
6. Prepare to put on sterile gloves. (Gloving oneself)
a. Open the sterile wrapper containing the sterile
gloves. Open the sterile glove wrapper while the
hands are still covered by the sleeves.
b. Lift the first glove from glove package by the
cuff of the glove
c. Place it in the hand to be gloved so that the
edge of the glove cuff is at the union of gown
and cuff. Palm to palm; thumb to thumb
d. Grasp the lower edge of glove cuff with fingers
on the hand being covered
e. Grasp upper edge of glove cuff with fungers of
other hand
f. Stretch and extend the glove cuff
g. Roll wrist of hand being covered so glove cuff
covers the linen cuff of the gown
h. Be sure glove covers all of the gown cuff
i. Do not touch gown cuff with other hand
j. Extend fingers into the glove fingers
k. Pull glove onto hand
7. Repeat for the other hand
8. Completing of gowning as follows:
 Have the circulating nurse hold the waist tie
at your gown, using sterile gloves or a sterile
forceps or drape
 Make a three-quarter turn, then take the tie
& secure it in front of the gown or
 Have a circulating nurse take the two ties at
each side of the gown, making sure that
your uniform is completely covered
 When worn, sterile gowns should be
considered sterile in front from waist to the
shoulder. The sleeves should be considered
sterile from 2 inches above the elbow to the
cuff since the arms of a scrubbed person
must move across a sterile field
9. Document the sterile technique used in the
performance of the procedure.
TOTAL

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Signature of Student Signature of Faculty