Participant Name: ____________________ Date: _______________ Result: __Pass / Fail___

Evaluator Name: _____________________ Signature: _____________________

Return Demonstration Checkoff: Cleaning and Dressing a Wound

Performance Criteria Met Not Met

Pre-Demonstration Preparation:
Hand Hygiene:
 Wash hands thoroughly with soap and water.
 Use hand sanitizer if soap and water are not available.
Gather Supplies:
 Ensure all necessary supplies are within reach.
 Confirm the availability of appropriate dressings, cleansing solutions,
and personal protective equipment (PPE).
Wound Assessment:
Identify the Wound:
 Clearly articulate the location, type, and characteristics of the wound.
Assess Exudate:
 Describe the amount and type of exudate present.
Check for Signs of Infection:
 Identify any signs of infection, such as redness, swelling, or increased
pain.
Cleaning the Wound:
Perform Hand Hygiene:
 Reiterate the importance of hand hygiene before touching the wound.
Cleanse Wound Appropriately:
 Use the correct cleansing solution (e.g., sterile saline).
 Demonstrate proper technique, avoiding excessive force.
Inspect for Debris:
 Identify and remove any debris using sterile tools if necessary.
Dressing Application:
Select Appropriate Dressing:
 Choose a dressing suitable for the wound type and exudate level.
Prepare the Dressing:
 If applicable, demonstrate the proper preparation of the dressing
according to guidelines.
Apply Dressing with Aseptic Technique:
 Use clean gloves and apply the dressing with an aseptic technique.
Secure the Dressing:
 Skin-prep the peri-wound
 Secure the dressing in place without causing discomfort to the patient.
Post-Demonstration Steps:
Dispose of Waste:
 Discard used materials into appropriate waste containers.
Perform Final Hand Hygiene:
 Reinforce the importance of hand hygiene after completing the
procedure.