SURGICAL HANDWASHING Name: ______________________________________ Year & Section: _______________________________

Legend: 5- Excellent 4- Very Good 3- Good 2- Fair RATING

Grade: _______________ Date: ________________

1- Poor 4

1.Checks completeness of supplies 2. Removes all pieces of jewelry 3. Trims nails if needed. Remove nail polish or artificial nails 4. Wears surgical mask. 5. Stands before the sink keeping body away from it. 6. Turns on the faucet and adjusts the pressure of the water using the foot or elbow control. 7.Hold hands below the elbows, wetting the skin from the fingertips to elbow 8. Wets and applies about 1 tsp of liquid antimicrobial soap on thepalm using foot control and works up a lather. 9. Using the prepackaged brush-sponge pad, open the package and removes the nail cleaner and cleans the nails on each hand and discard the cleaner. 10. Removes the brush from the package and discard the wrapper without putting down the brush for the scrub will begin 11. Moisten the brush or pad and dispenses the soap into it (if the brush is not impregnated with the cleaning agent) 12. Using the brush, makes 20 strokes on the nails. 13. Using circular strokes, scrub all skin surfaces of a. Each fingers b. Palms c. Back of the hands d. Forearms (divide into two then 10 strokes on each 4 parts of the first half of the forearm then another 10 strokes on each parts of the second half of the forearm paying extra attention on the elbow) 14. After scrubbing on the less dominant hand, rinses the brush and continues the procedure on the dominant hand. 15. When the scrub is finished on the dominant hand, drops the brush and with the use of the foot control, turns on the water allowing the water to run from the fingertips to the elbow. 16. Turns off the water using foot control, knee or elbow control 17. Position the hands and elbows above waist without touching any part of the scrub uniform 18. Enters the swing door of the operating room using the back or the buttocks then turns toward the back table to grab the sterile gown. Comments:

__________________________________________ Name and Signature of the Students

____________________________________ Name and Signature of the Clinical Instructor