Republic of the Philippines
Isabela State University
Echague, Isabela
PERFORMANCE EVALUATION CHECKLIST
Name: Rating:
Course/Year/Group:
SKILL: Donning a Sterile Gown and Gloves (Closed Method)
PREPARATION 0 1 2 Comments
1. Check the client and ask about latex allergies.
Use non-latex whenever possible.
2. Assemble equipment:
Sterile pack containing a sterile gown
Sterile gloves
3. Ensure the sterility of the package of gloves
PROCEDURE
1. Perform hand hygiene.
2. Observe appropriate infection control
procedures.
3. Provide for client privacy.
Donning a Sterile Gown
4. Open the package of sterile gloves.
Remove the outer wrap from the sterile gloves
and leave the gloves in their inner sterile wrap on
the sterile field.
5. Unwrap the sterile gown pack
6. Put on the sterile gown.
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.
Put the hands inside the shoulders of the gown,
and work the arms partway into the sleeves
without touching the outside of the gown.
If donning sterile gloves using the closed
method, work the hands down the sleeves only to
the proximal edge of the cuffs;
Or
If donning sterile gloves by using the open
method, work the hands down the sleeves and
through the cuffs.
Have a co-worker 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 co-worker ties the
neck ties. Gowning continues at step 11.
Donning Sterile Gloves (Closed Method)
7. Open the sterile wrapper containing the sterile
gloves.
Open the sterile glove wrapper while the hands
are still covered by the sleeves.
8. Put the glove on the non-dominant hand
With the dominant hand, pick up the opposite
glove with the thumb and index finger, handling
it through the sleeve.
Lay the glove on the opposite gown cuff, thumb
side down, with the glove opening pointed
toward the fingers. Position the dominant hand
palm upward inside the sleeve.
Use the non-dominant hand to grasp the cuff of
the glove through the gown cuff, and firmly
anchor it.
With the dominant hand working through its
sleeve, grasp the upper side of the glove’s cuff,
and stretch it over the cuff of the gown.
Pull the sleeve up to draw the cuff over the wrist
as you extend the fingers of the non-dominant
hand into the glove’s fingers.
9. Put the glove on the dominant hand.
Place the fingers of the gloved hand under the
cuff of the remaining glove.
Place the glove over the cuff of the second
sleeve.
Extend the fingers into the glove as you pull the
glove up over the cuff.
Completion of Gowning
10. Complete gowning as follows:
Have a co-worker hold the waist tie of your
gown, using sterile gloves or a sterile forceps or
drape.
Make a three-quarter turn, then take the tie and
secure it in front of the gown.
Or
Have a co-worker take the two ties at each side of
the gown, making sure that your uniform is
completely covered.
11. When worn, sterile gowns should be considered
sterile in front from the 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.
There is no special technique for removing sterile
attire. If they are soiled, remove them by turning
them inside out.
12. If appropriate, document that sterile technique
was used in the performance of the procedure.
Note: You are rated using the criteria below:
0 – Missed/Failed to do the procedure.
1 – Performed procedure but failed to explain the rationale for doing the procedure.
2 – Performed procedure with confidence and explained the reason for doing said procedure.
Rating: RS x 100
N Name and Signature of Professor
Where: RS = Raw Score Date:
N = Total number of items
Republic of the Philippines
Isabela State University
Echague, Isabela
PERFORMANCE EVALUATION CHECKLIST
Name: Rating:
Course/Year/Group:
SKILL: Donning and Removing Sterile Gloves (Open Method)
PREPARATION 0 1 2 Comments
1. Check client record and ask the client about latex
allergies.
2. Assemble equipment:
Packages of sterile gloves
PROCEDURE
1. Introduce yourself and verify the client’s
identity. Explain to the client what you are going
to do, why is it necessary, and how the client can
cooperate.
2. Open the package of sterile gloves.
- Place the package of gloves on a clean, dry
surface.
- If the gloves are packed in an inner as well
as an outer package, open the outer package
without contaminating the gloves or the
inner package.
- Remove the inner package from the outer
package.
- Open the inner package as in step 4 of the
Skill: Establishing and Maintaining a Sterile
Field, or according to the manufacturer’s
directions. If no tabs are provided, pluck the
flap so that the fingers do not touch the inner
surfaces.
3. Put the first glove on the dominant hand.
- If the gloves are packaged so that they lie side by
side, grasp the glove for the dominant hand by its
folded cuff edge (on the palmar side) with the
thumb and first finger of the non-dominant hand.
Touch only the inside of the cuff;
Or
- If the gloves are packaged one on top of the
other, grasp the cuff of the top glove as above,
using the opposite hand.
- Insert the dominant hand into the glove and pull
the glove on. Keep the thumb of the inserted
hand against the palm of the hand during
insertion.
- Leave the cuff in place once the non-sterile hand
releases the glove.
4. Put the second glove on the non-dominant hand.
- Pick up the outer glove with the sterile gloved
hand, inserting the gloved fingers under the cuff
and holding the gloved thumb close to gloved
palm.
- Pull on the second glove carefully. Hold the
thumb of the gloved first hand as far as possible
from the palm.
- Adjust each glove so that it fits smoothly,
carefully pull the cuffs up by sliding the fingers
under the cuffs.
5. Remove the dispose of used gloved.
- There is no special technique for removing sterile
gloves. If they are soiled with secretions, remove
them by turning them inside out.
6. Document that sterile technique was used in the
performance of the procedure.
Note: You are rated using the criteria below:
0 – Missed/Failed to do the procedure.
1 – Performed procedure but failed to explain the rationale for doing the procedure.
2 – Performed procedure with confidence and explained the reason for doing said procedure.
Rating: RS x 100
N Name and Signature of Professor
Where: RS = Raw Score Date:
N = Total number of items
