Nursing Skills Checklist: Chapter 23 – Flashcards

The application and use of hand hygiene is appropriate for all health care providers. Equipment needed: antimicrobial or nonantimicrobial soap (if in bar form, soap must be placed on a soap rack), paper towels, and oil free lotion. *1)* Gather the necessary supplies. Stand in front of the sink. Do NOT allow your clothing to touch the sink during the washing procedure. (Rationale: the sink is contaminated. Clothing may carry organisms from place to place.) *2)* Remove jewelry, if possible, and secure in a safe place. (Rationale: Removal of jewelry facilitates proper cleansing.) *3)* Turn on water and adjust force. Regulate the temperature until the water is warm. (Rationale: Water splashed from the contaminated sink will contaminate clothing.) *4)* Wet the hands and wrist area. Keep hands lower than elbows to allow water to flow toward fingertips. (Rationale: Water should flow from the cleaner area toward the more contaminated area. Hands are more contaminated than forearms.) *5)* Use about 1 teaspoon liquid soap from dispenser or rinse bar of soap and lather thoroughly. Cover all areas of hands with the soap product. Rinse soap bar again and return soap to rack without touching the rack. (Rationale: Rinsing the soap before and after use removes the lather, which may contain microorganisms.) *6)* With firm rubbing and circular motions, wash the palms and backs of the hands, each finger, the areas between the fingers, and the knuckles, wrists, and forearms. *WASH AT LEAST 1 INCH ABOVE AREA OF CONTAMINATION.* If hands are not visibly soiled, wash to 1 inch above the wrists. (Rationale: Friction caused by firm rubbing and circular motions helps to loosen dirt and organisms that can lodge between the fingers and other places) *7)* Continue this friction motion for at least 20 seconds. (Rationale: Length of hand washing is determined by degree of contamination. Hands that are visibly soiled need a longer scrubs.) *8)* Use fingernails of the opposite hand or a clean orangewood stick to clean under fingernails. (Rationale: Area under nails has a high microorganism count, and organisms may remain under the nails, where they can grow and be spread to other persons.) *9)* Rinse thoroughly with water flowing toward fingertips. (Rationale: Running water rinses microorganisms and dirt into the sink.) *10)* Pat hands dry with a paper towel, beginning with the fingers and moving upward toward forearms, and discard it immediately. Use another clean towel to turn off the faucet. Discard towel immediately without touching other clean hand. (Rationale: Patting the skin dry prevents chapping. Dry hands first because they are considered the cleanest and least contaminated area.) *11)* Use oil-free lotion on hands if desired. (Rational: Oil free lotion helps to keep the skin soft and prevents chapping. It is best to apply after patient care is complete and from a small, personal container. Oil-based lotions should be avoided because they can cause deterioration of glove.

*1)* Apply product to the palm of one hand, using the amount of product recommended on the package (it will vary according to the manufacturer but usually is 1 to 3 mL). *2)* Rub hands together, making sure to cover all surfaces of the hands, fingers, and in between the fingers. Also, clean the fingertips and the area beneath the fingernails. *3)* Continue rubbing until the hands are dry (at least 15 seconds).

*1)* Check medical record and nursing plan of care for type of precautions and review precautions in infection control manual. (Rationale: Mode of transmission of organism determines type of precautions required). *2)* Plan nursing activities before entering patient's room. (Rationale: Organization facilitates performance of task and adherence to precautions). *3)* Perform hand hygiene. (Rational: Hand hygiene prevents the spread of microorganisms). *4)* Provide the instruction about precautions to patient, family members, and visitors. (Rationale: Explanation encourages cooperation of patient and family, and reduces apprehension about precaution procedures.) *5)* Put on gown, mask, protective eyewear, and gloves based on the type of exposure anticipated and category of isolation precautions. (Rationale: Use of PPE interrupts chain of infection and protects patient and nurse. Gown should protect entire uniform. Gloves protect hands and wrists from microorganisms. Masks protect nurse or patient from droplet nuclei and large-particle aerosols. Eyewear protects mucous membranes in the eye from splashes.) >>>Put on gown, with the opening in the back. Tie gown securly at neck. >>>Put on the mask or respirator over your nose, mouth, and chin. Secure ties or elastic bands at the middle of the head and neck. If respirator is used perform a fit check. Inhale; the respirator should collapse. Exhale; air should not leak out. >>>Put on goggles. Place over eyes and adjust to fit. Alternately, a face shield could be used to take the place of the mask and goggles. >>>Put on clean disposable gloves. Extend gloves to cover the cuffs of the gown. *6)* Identify the patient. Explain the procedure to the patient. Continue with patient care as appropriate. (Rationale: Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.) *Removing PPE* *7)* Removing PPE: Except for respirator, remove PPE at the doorway or in an anteroom. *Remove respirator after leaving the patient's room and closing the door.* (Rationale: Proper removal prevents contact with and the spread of microorganisms. Removing respirator outside of the patient's room prevents contact with airborne microorganisms.) >>>If impervious gown has been tied in front of body at the waistline, untie waist strings before removing gloves. (Rationale: Outside front of equipment is considered contaminated. The inside, outside back, ties on head and back, are considered clean, which are areas of PPE that are not likely to have been in contact with infectious organisms.) >>>Grasp the outside of one glove with the opposite gloved hand and peel off, turning the glove inside out as you pull it off. Hold the removed glove in the remaining gloved hand. >>>Slide the fingers of the ungloved hand under the remaining glove at the wrist *taking care not to touch the outer surface of the glove* >>>Peel off the glove over the first glove, containing the one glove inside the other. Discard in the appropriate container. >>>To remove the goggles or face sheild: Handle by the headband or earpieces. Lift away from the face. Place in designated receptacle for reprocessing or in an appropriate waste container. (Rationale: Outside of goggles or face sheild is contaminated *DO NOT TOUCH*. Handling by the headband or earpieces and lifting away from face prevents transmission of microorganisms.) >>>To remove gown: Unfasten ties, if at the neck and back. Allow the gown to fall away from shoulders. *Touching only the inside of the gown,* pull away from the torso. Keeping hands on the inner surface of the gown, pull gown from arms. Turn gown inside out. Fold or roll into a bundle and discard. (Rationale: Gown front and sleeves are contaminated. Touching only the inside of the gown and pulling it away from the torso prevents transmission of microorganisms. Proper disposal prevents transmission of microorganisms). >>>To remove mask or respirator: Grasp the neck ties or elastic, then top ties or elastic and remove. *Take care to avoid touching front of mask or respirator.* Discard in waste container. If using a respirator, save for future use in the designated area. (Rationale: Front of mask or respirator is contaminated. *DO NOT TOUCH.* Not touching the front and proper disposal prevent transmission of microorganisms.) *8)* Perform hand hygiene immediately after removing all PPE.

*1)* Perform hand hygiene and put on PPE, if indicated. (Rationale: Hand hygiene and PPE prevent the spread of microorganisms. PPE is required, based on transmission precautions.) *2)* Identify the patient. Explain the procedure to the patient. (Rationale: Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect.) *Preparing a Sterile Field* *3)* Check that packaged sterile drape is dry and unopened. Also, note expiration date, making sure that the date is still valid. (Rationale: Moisture contaminates a sterile package. Expiration date indicated period that package remains sterile). *4)* Select a work area that is waist level or higher. (Rationale: Work area is within sight. Bacteria tend to settle, so there is less contamination above the waist). *5)* Open sterile wrapped drape or commercially prepared kit following the directions below. >>>*For prepackaged sterile drape* >>>a) Open the outer covering of the drape. Remove sterile drape lifting it carefully by its corners. Hold away from body and above the waist and work surface. (Rationale: Outer 1 inch of drape is considered contaminated. Any item touching this area is also considered contaminated.) >>>b) Continue to hold only by the corners. Allow the drape to unfold, away from your body and any other surface. (Rationale: Touching outer side of wrapper maintains the sterile field. Contact with and surface would contaminate the field.) >>>c) Position the drape on the work surface with the moisture-proof side down. This would be the shiny or blue side. Avoid touching any other surface or object with the drape. If any portion of the drape hangs off the work surface, that part of the drape is considered contaminated. Do not touch or reach over the sterile field. (Rationale: Moisture-proof side prevents contamination of the field if it becomes wet. The moisture penetrates the sterile cloth or paper and carries organisms by capillary action to contaminate the field. A wet field is considered contaminated if the surface immediately below it is not sterile. >>>*For a commercially packaged prepared kit or tray:* >>>a) Open the outside cover of the package and remove the kit or tray. Place in the center of the work surface, with the topmost flap positioned on the far side of the package. Discard outside cover. (Rationale: This allows sufficient rooms for sterile field.) >>>b) Reach around the package and grasp the outer surface of the end of the topmost flap, holding no more than 1 inch from the border of the flap. Pull open away from the body, keeping the arm outstretched and away from the inside of the wrapper. Allow the wrapper to lie flat on the work surface. (Rationale: This maintains sterility of inside of wrapper, which is to become the sterile field. Outer surface of the wrapper is considered unsterile.) >>>Stand away from the package and work surface. Grasp the outer surface of the remaining flap closest to the body, holding not more than 1 inch from the border of the flap. Pull the flap back toward the body, keeping arm outstretched and awat from the inside of the wrapper. Keep this hand in place. Use other hand to grasp the wrapper on the underside (the side that is down to the work surface). Position the wrapper so that when flat, edges are on the work surface, and do not hang down over sides of work surface. Allow the wrapper to lie flat on the work surface. (Rationale: This maintains sterility of inside of wrapper, which is to become the sterile field. Outer surface of the wrapper is considered unsterile. Outer 1-inch border of the wrapper is considered contaminated. >>>The outer wrapper of the package has become a sterile field with the packaged supplies in the center. Do not touch or reach over the sterile field. (Rationale: Sterility of the field and contents are maintained).

*>>>Adding Items to a Sterile Field* *6)* Place additional sterile items on field as needed. (Rationale: Sterility of the field is maintained). *>>>To Add and Agency Wrapped and Sterilized Items* a) Hold agency-wrapped item in the dominant hand, with top flap opening away from the body. With other hand, reach around the package and unfold top flap and both sides. (Rationale: Only sterile surface and items are exposed before dropping onto sterile field). b) Keep a secure hold on item through the wrapper with the dominant hand. Grasp the remaining flap of the wrapper closet to the body, taking care not to touch the inner surface of the wrapper or the item. Pull the flap back toward the wrist, so the wrapper covers the hand and wrist. (Rationale: Only sterile surface and item are exposed before dropping onto the sterile field). c) Grasp all the corners of the wrapper together with the non-dominant hand and pull back toward wrist, covering hand and wrist. Hold in place. (Rationale: Only sterile surface and item are exposed before dropping onto sterile field). d) Hold the item 6 inches above the surface of the sterile field and drop onto the field. Be careful to avoid touching the surface or other items or dropping onto the 1 inch border. (Rationale: This prevents contamination of the field and inadvertent dropping of the sterile item too close to the edge or off the field. Any items landing on the 1-inch border are considered contaminated). *>>>To Add a Commercially Wrapped and Sterilized Item* a) Hold package in one hand. Pull back top cover with other hand. Alternately, carefully peel the edges apart using both hands. (Rationale: Contents remain uncontaminated by hands). b) After top cover or edges are partially separated, hold the item 6 inches above the surface of the sterile field. Continue opening the package and drop the item onto the field. *Be careful to avoid touching the surface or other items or dropping onto the 1-inch border.* (Rationale: This prevents contamination of the field and inadvertent dropping of the sterile item too close to the edge or off the field. Any items landing on 1-inch border are considered contaminated). c) Discard wrapper. (Rationale: A neat work area promotes proper technique and avoids inadvertent contamination of the field). *>>>To Add a Sterile Solution* a) Obtain appropriate solution and check expiration date. (Rationale: Once opened, label any bottles with date and time. Solution remains sterile for 24 hours once opened. b) Open solution container according to directions and *place cap on table away from the field with edges up.* (Rationale: Sterility of inside cap is maintained). c) Hold bottle outside the edge of the sterile field with the label side facing the palm of your hand and prepare to pour from a height of 4 to 6 inches. *Never touch the tip of the bottle to the sterile container or field*. (Rationale: Label remains dry, and solution may be poured without reaching across sterile field. Minimal splashing occurs from that height. Accidentally touching the tip of the bottle to a container or dressing contaminates them both). d) Pour required amount of solution steadily into sterile container previously added to sterile field and positioned at side of sterile field or onto dressings. *Avoid splashing any liquid.* (Rationale: A steady stream minimizes the risk of splashing; moisture contaminates sterile field). e) Touch only the outside of the lid when recapping. Label solution with the date and time of opening. (Rationale: Solution remains uncontaminated and available for future use. *7)* Continue with the procedure as indicated. *8)* When procedure is completed, remove PPE, if used. Perform hand hygiene. (Rationale: Removing PPE properly reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms).

*1)* Perform hand hygiene and put on PPE, if indicated. (Rationale: Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions). *2)* Identify the patient. Explain the procedure to the patient. (Rationale: Patient identification validates the correct patient and correct procedure. Discussion and explanation help allay anxiety and prepare the patient for what to expect). *3)* Check that the sterile glove package is dry and unopened. Also note expiration date, making sure that the date is still valid. (Rationale: Moisture contaminates a sterile package. Expiration date indicates the period that the package remains sterile). *4)* Place sterile glove package on clean, dry surface at or above your waist. (Rationale: Moisture could contaminate the sterile gloves. Any sterile object held below the waist is considered contaminated). *5)* Open the outside wrapper by carefully peeling the top layer back. Remove inner package, handling only the outside of it. (Rationale: This maintains sterility of gloves in inner packet). *6)* Place the inner package on the work surface with the side labeled "cuff end" closest to the body. (Rationale: Allows for ease of glove application). *7)* Carefully open the inner package. Fold open the top flap, then the bottom and sides. *Take care not to touch the inner surface of the package or the gloves. (Rationale: The inner surface of the package is considered sterile. The outer 1-inch border of the inner package is considered contaminated. The sterile gloves are exposed with the cuff end closest to the nurse). *8)* With the thumb and forefinger of the nondominate hand, grasp the folded cuff of the glove for the dominant hand, touching only the exposed inside of the glove. (Rationale: Unsterile hand touches only inside of glove. Outside remains sterile). *9)* Keeping the hands about the waistline, life and hold the glove up and off the inner package with fingers down. *Be cafeful that it does not touch any unsterile object*. (Rationale: Glove is contaminated if it touches any unsterile objects). *10)* Carefully insert dominant hand palm up into the glove and pull glove on. Leave the cuff folded until the opposire hand is gloved. (Rationale: Attempting to turn upward with unsterile hand may resule in contamination of sterile glove). *11)* Hold the thumb of the gloved hand outward. Place the fingers of the gloved hand inside the cuff of the remaining glove. Lift it from the wrapper, taking care not to touch anything with the gloves or hands. (Rationale: Thumb is less likely to become contaminated if held outward. Sterile surface touching sterile surface prevents contamination). *12)* Carefully insert nondominant hand into glove. Pull the glove on, taking care that the skin does not touch any of the outer surfaces of the glove. (Rationale: Sterile surface touching sterile prevents contamination). *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.* (Rationale: Sterile surface touching sterile prevents contamination). *14)* Adjust gloves on both hands if necessary, *touching only sterile areas with other sterile areas.* (Rationale: Sterile surface touching sterile prevents contamination). *15)* Continue with procedure as indicated. *Removing Soiled Gloves* *16)* Use dominant hand to grasp the opposite glove *near cuff end on the outside exposed area*. Remove it by pulling it off, inverting it as it is pulled, keeping the contaminated are on the inside. Hold the removed glove in the remaining hand. (Rationale: Contaminated area does not come in contact with hands or wrists). *17)* Slide fingers of ungloved hand between the remaining glove and the wrist. *Take care to avoid touching the outside surface of the glove.* Remove it by pulling it off, inverting it as it is pulled, keeping the contaminated area on the inside, and securing the first glove inside the second. (Rationale: Contaminated area does not come in contact with hands or wrists). *18)* Discard gloves in appropriate container. Remove additional PPE, if used. Perform hand hygiene).