SkIll 1-1 Performing Hand Hygiene Using an Excellent Satisfactory...

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Copyright © 2015 by Wolters Kluwer. Skill Checklists for Taylor's Clinical Nursing Skills: A Nursing Process Approach, 4th edition, by Pamela Lynn.

Skill Checklists for Taylor's Clinical Nursing Skills:A Nursing Process Approach, 4th edition

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Unit Position

Instructor/Evaluator: Position

SkIll 1-1

Performing Hand Hygiene Using an Alcohol-Based Handrub

Goal: Transient microorganisms are eliminated from the hands. Comments

1.Removejewelry,ifpossible,andsecureinasafeplace.Aplainweddingbandmayremaininplace.

2.Checktheproductlabelingforcorrectamountofproductneeded.

3.Applythecorrectamountofproducttothepalmofonehand.Rubhandstogether,coveringallsurfacesofhandsandfingers,andbetweenfingers.Alsocleanthefingertipsandtheareabeneaththefingernails.

4.Rubhandstogetheruntiltheyaredry(atleast15seconds).

5.Useoil-freelotiononhands,ifdesired.

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1. Gatherthenecessarysupplies.Standinfrontofthesink.Donotallowyourclothingtotouchthesinkduringthewashingprocedure.

2. Removejewelry,ifpossible,andsecureinasafeplace.Aplainweddingbandmayremaininplace.

3. Turnonwaterandadjustforce.Regulatethetemperatureuntilthewateriswarm.

4. Wetthehandsandwristarea.Keephandslowerthanelbowstoallowwatertoflowtowardfingertips.

5. Useabout1teaspoonliquidsoapfromdispenserorrinsebarofsoapandlatherthoroughly.Coverallareasofhandswiththesoapproduct.Rinsesoapbaragainandreturntosoaprackwithouttouchingtherack.

6. Withfirmrubbingandcircularmotions,washthepalmsandbacksofthehands,eachfinger,theareasbetweenthefingers,andtheknuckles,wrists,andforearms.Wash at least 1 inch above area of contamination.Ifhandsarenotvisiblysoiled,washto1inchabovethewrists.

7. Continuethisfrictionmotionforatleast20seconds.

8. Usefingernailsoftheoppositehandoracleanorange-woodsticktocleanunderfingernails.

9. Rinsethoroughlywithwaterflowingtowardfingertips.

10. Pathandsdrywithapapertowel,beginningwiththefin-gersandmovingupwardtowardforearms,anddiscarditimmediately.Useanothercleantoweltoturnoffthefaucet.Discardtowelimmediatelywithouttouchingothercleanhand.

11.Useoil-freelotiononhands,ifdesired.

SkIll 1-2

Performing Hand Hygiene Using Soap and Water (Handwashing)

Goal: The hands will be free of visible soiling and transient microorganisms will be eliminated. Comments

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1.Checkmedicalrecordandnursingplanofcarefortypeofprecautionsandreviewprecautionsininfectioncontrolmanual.

2.Plannursingactivitiesbeforeenteringpatient’sroom.

3.Performhandhygiene.

4.Provideinstructionaboutprecautionstopatient,familymembers,andvisitors.

5.Putongown,mask,protectiveeyewear,andglovesbasedonthetypeofexposureanticipatedandcategoryofisolationprecautions.

a. Putonthegown,withtheopeningintheback.Tiegownsecurelyatneckandwaist.

b.Putonthemaskorrespiratoroveryournose,mouth,andchin.Securetiesorelasticbandsatthemiddleoftheheadandneck.Ifrespiratorisused,performafitcheck.Inhale;therespiratorshouldcollapse.Exhale;airshouldnotleakout.

c. Putongoggles.Placeovereyesandadjusttofit.Alter-nately,afaceshieldcouldbeusedtotaketheplaceofthemaskandgoggles.

d.Putoncleandisposablegloves.Extendglovestocoverthecuffsofthegown.

6.Identifythepatient.Explaintheproceduretothepatient.Continuewithpatientcareasappropriate.

SkIll 1-3

Using Personal Protective Equipment

Goal: The transmission of microorganisms is prevented. Comments

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SkIll 1-3

Using Personal Protective Equipment (Continued)

Comments

Remove PPE

7.RemovePPE:Exceptforrespirator,removePPEatthedoor-wayorinananteroom.Remove respirator after leaving the patient’s room and closing the door.

a. Ifimperviousgownhasbeentiedinfrontofthebodyatthewaistline,untiewaiststringsbeforeremovinggloves.

b.Grasptheoutsideofoneglovewiththeoppositeglovedhandandpeeloff,turningthegloveinsideoutasyoupullitoff.Holdtheremovedgloveintheremainingglovedhand.

c. Slidefingersofunglovedhandundertheremaininggloveatthewrist,taking care not to touch the outer surface of the glove.

d.Peeloffthegloveoverthefirstglove,containingtheonegloveinsidetheother.Discardinappropriatecontainer.

e. Toremovethegogglesorfaceshield:Handlebythehead-bandorearpieces.Liftawayfromtheface.Placeindesig-natedreceptacleforreprocessingorinanappropriatewastecontainer.

f. Toremovegown:Unfastenties,ifattheneckandback.Allowthegowntofallawayfromshoulders.Touching only the inside of the gown,pullawayfromthetorso.Keepinghandsontheinnersurfaceofthegown,pullgownfromarms.Turngowninsideout.Foldorrollintoabundleanddiscard.

g. Toremovemaskorrespirator:Graspthenecktiesorelastic,thentoptiesorelasticandremove.Take care to avoid touching front of mask or respirator.Discardinwastecontainer.Ifusingarespirator,saveforfutureuseinthedesignatedarea.

8.PerformhandhygieneimmediatelyafterremovingallPPE.

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1.PerformhandhygieneandputonPPE,ifindicated.

2.Identifythepatient.Explaintheproceduretothepatient.

3.Checkthatpackagedsteriledrapeisdryandunopened.Alsonoteexpirationdate,makingsurethatthedateisstillvalid.

4.Selectaworkareathatiswaistlevelorhigher.

5.Opentheoutercoveringofthedrape.Removesteriledrape,liftingitcarefullybyitscorners.Holdawayfrombodyandabovethewaistandworksurface.

6.Continuetoholdonlybythecorners.Allowthedrapetounfold,awayfromyourbodyandanyothersurface.

7.Positionthedrapeontheworksurfacewiththemoisture-proofsidedown.Thiswouldbetheshinyorblueside.Avoidtouchinganyothersurfaceorobjectwiththedrape.Ifanyportionofthedrapehangsofftheworksurface,thatpartofthedrapeisconsideredcontaminated.

8.Placeadditionalsterileitemsonfieldasneeded.RefertoSkill1-6.Continuewiththeprocedureasindicated.

9.Whenprocedureiscompleted,removePPE,ifused.Performhandhygiene.

SkIll 1-4

Preparing a Sterile Field Using a Packaged Sterile Drape

Goal: The sterile field is created without contamination and the patient remains free of exposure to potential infection- causing microorganisms. Comments

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1. PerformhandhygieneandputonPPE,ifindicated.

2. Identifythepatient.Explaintheproceduretothepatient.

3. Checkthatthepackagedkitortrayisdryandunopened.Alsonoteexpirationdate,makingsurethatthedateisstillvalid.


5. Opentheoutsidecoverofthepackageandremovethekitortray.Placeinthecenteroftheworksurface,withthetopmostflappositionedonthefarsideofthepackage.Discardoutsidecover.

6. Reacharoundthepackageandgrasptheoutersurfaceoftheendofthetopmostflap,holdingnomorethan1inchfromtheborderoftheflap.Pullopenawayfromthebody,keepingthearmoutstretchedandawayfromtheinsideofthewrapper.Allowthewrappertolieflatontheworksurface.

7. Reacharoundthepackageandgrasptheoutersurfaceofthefirstsideflap,holdingnomorethan1inchfromtheborderoftheflap.Pullopentothesideofthepackage,keepingthearmoutstretchedandawayfromtheinsideofthewrapper.Allowthewrappertolieflatontheworksurface.

8. Reacharoundthepackageandgrasptheoutersurfaceoftheremainingsideflap,holdingnomorethan1inchfromtheborderoftheflap.Pullopentothesideofthepackage,keep-ingthearmoutstretchedandawayfromtheinsideofthewrapper.Allowthewrappertolieflatontheworksurface.

SkIll 1-5

Preparing a Sterile Field Using a Commercially Prepared Sterile Kit or Tray

Goal: A sterile field is created without contamination, the contents of the package remain sterile, and the patient remains free of exposure to potential infection-causing microorganisms. Comments

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SkIll 1-5

Preparing a Sterile Field Using a Commercially Prepared Sterile Kit or Tray (Continued)

Comments

9. Standawayfromthepackageandworksurface.Grasptheoutersurfaceoftheremainingflapclosesttothebody,holdingnotmorethan1inchfromtheborderoftheflap.Pulltheflapbacktowardthebody,keepingarmout-stretchedandawayfromtheinsideofthewrapper.Keepthishandinplace.Useotherhandtograspthewrapperontheunderside(thesidethatisdowntotheworksurface).Positionthewrappersothatwhenflat,edgesareontheworksurface,anddonothangdownoversidesofworksurface.Allowthewrappertolieflatontheworksurface.

10. Theouterwrapperofthepackagehasbecomeasterilefieldwiththepackagedsuppliesinthecenter.Donottouchorreachoverthesterilefield.Placeadditionalsterileitemsonfieldasneeded.RefertoSkill1-6.Continuewiththeprocedureasindicated.

11. Whenprocedureiscompleted,removePPE,ifused.Performhandhygiene.

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1.PerformhandhygieneandputonPPE,ifindicated.

2.Identifythepatient.Explaintheproceduretothepatient.

3.Checkthatthesterile,packageddrapeandsuppliesaredryandunopened.Alsonoteexpirationdate,makingsurethatthedateisstillvalid.


5.PreparesterilefieldasdescribedinSkill1-4orSkill1-5.

6.Addsterileitem:

To Add an Agency-Wrapped and Sterilized Item

a. Holdagency-wrappediteminthedominanthand,withtopflapopeningawayfromthebody.Withotherhand,reacharoundthepackageandunfoldtopflapandbothsides.

b. Keepasecureholdontheitemthroughthewrapperwiththedominanthand.Grasptheremainingflapofthewrapperclosesttothebody,takingcarenottotouchtheinnersurfaceofthewrapperortheitem.Pulltheflapbacktowardthewrist,sothewrappercoversthehandandwrist.

c. Graspallthecornersofthewrappertogetherwiththenondominanthandandpullbacktowardwrist,coveringhandandwrist.Holdinplace.

d.Holdtheitem6inchesabovethesurfaceofthesterilefieldanddropontothefield.Becarefultoavoidtouchingthesurfaceorotheritemsordroppinganyitemontothe1-inchborder.

To Add a Commercially Wrapped and Sterilized Item

a. Holdpackageinonehand.Pullbacktopcoverwithotherhand.Alternately,carefullypeeltheedgesapartusingbothhands.

b.Aftertopcoveroredgesarepartiallyseparated,holdtheitem6inchesabovethesurfaceofthesterilefield.Con-tinueopeningthepackageanddroptheitemontothefield.Be careful to avoid touching the surface or other items or dropping an item onto the 1-inch border.

c. Discardwrapper.

SkIll 1-6

Adding Sterile Items to a Sterile Field

Goal: The sterile field is created without contamination, the sterile supplies are not contaminated, and the patient remains free of exposure to potential infection-causing microorganisms. Comments

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SkIll 1-6

Adding Sterile Items to a Sterile Field (Continued)

Comments

To Add a Sterile Solution

a. Obtainappropriatesolutionandcheckexpirationdate.

b.Opensolutioncontaineraccordingtodirectionsandplace cap on table away from the field with edges up.

c. Holdbottleoutsidetheedgeofthesterilefieldwiththelabelsidefacingthepalmofyourhandandpreparetopourfromaheightof4to6inches(10to15cm).Never touch the tip of the bottle to the sterile container or field.

d.Pourrequiredamountofsolutionsteadilyintosterilecontainerpreviouslyaddedtothesterilefieldandposi-tionedatsideofsterilefieldorontodressings.Avoid splashing any liquid.

e. Touchonlytheoutsideofthelidwhenrecapping.Labelsolutionwithdateandtimeofopening.

7.Continuewithprocedureasindicated.

8.Whenprocedureiscompleted,removePPE,ifused.Performhandhygiene.

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1. PerformhandhygieneandputonPPE,ifindicated.

2. Identifythepatient.Explaintheproceduretothepatient.

3. Checkthatthesterileglovepackageisdryandunopened.Alsonoteexpirationdate,makingsurethatthedateisstillvalid.

4. Placesterileglovepackageonclean,drysurfaceatoraboveyourwaist.

5. Opentheoutsidewrapperbycarefullypeelingthetoplayerback.Removeinnerpackage,handlingonlytheout-sideofit.

6. Placetheinnerpackageontheworksurfacewiththesidelabeled“cuffend”closesttothebody.

7. Carefullyopentheinnerpackage.Foldopenthetopflap,thenthebottomandsides.Take care not to touch the inner surface of the package or the gloves.

8. Withthethumbandforefingerofthenondominanthand,graspthefoldedcuffofthegloveforthedominanthand,touchingonlytheexposedinsideoftheglove.

9. Keepingthehandsabovethewaistline,liftandholdthegloveupandofftheinnerpackagewithfingersdown.Be careful that it does not touch any unsterile object.

10. Carefullyinsertdominanthandpalmupintogloveandpullgloveon.Leavethecufffoldeduntiltheoppositehandisgloved.

11. Holdthethumboftheglovedhandoutward.Placethefin-gersoftheglovedhandinsidethecuffoftheremainingglove.Liftitfromthewrapper,takingcarenottotouchanythingwiththeglovesorhands.

12. Carefullyinsertnondominanthandintoglove.Pullthegloveon,takingcarethattheskindoesnottouchanyoftheoutersurfacesofthegloves.

13. Slide the fingers of one hand under the cuff of the other and fully extend the cuff down the arm, touching only the sterile outside of the glove. Repeat for the remaining hand.

SkIll 1-7

Putting on Sterile Gloves and Removing Soiled Gloves

Goal: The gloves are applied and removed without contamination. Comments

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SkIll 1-7

Putting on Sterile Gloves and Removing Soiled Gloves (Continued)

Comments

14. Adjustglovesonbothhandsifnecessary,touching only sterile areas with other sterile areas.

15. Continuewithprocedureasindicated.

Removing Soiled Gloves

16. Usedominanthandtograsptheoppositeglovenear cuff end on the outside exposed area.Removeitbypullingitoff,invertingitasitispulled,keepingthecontaminatedareaontheinside.Holdtheremovedgloveintheremain-ingglovedhand.

17. Slidefingersofunglovedhandbetweentheremaininggloveandthewrist.Take care to avoid touching the out-side surface of the glove.Removeitbypullingitoff,invertingitasitispulled,keepingthecontaminatedareaontheinside,andsecuringthefirstgloveinsidethesecond.

18. Discardglovesinappropriatecontainer.Removeaddi-tionalPPE,ifused.Performhandhygiene.

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