Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES
Name: ___________________________________________ Grade: _________
Year & Section: ____________________________________ Date: __________
Group No: ________________________________________
PROCEDURE CHECKLIST
APPLYING & REMOVING STERILE GLOVES (OPEN METHOD)
Instruction: Below is the grading scale which will be used in rating your performance.
5 EXCELLENT 95 - 100
4 VERY SATISFACTORY 88 - 94
3 SATISFACTORY 82 – 87
2 FAIR 76 – 81
1 NEEDS PRACTICE 70 – 75
A. PURPOSES
To enable the nurse to handle or touch sterile objects freely without contaminatin
g them.
To prevent transmission of potentially infective organisms from the nurse’s hands
to clients at high risk for infection.
B. ASSESSMENT
Review the client’s record and orders to determine exactly what procedure will be
performed that requires sterile gloves. Check the client record and ask about late
x allergies. Use nonlatex gloves whenever possible.
C. PLANNING
Think through the procedure, planning which steps need to be completed before
the gloves can be applied. Determine what additional supplies are needed to
perform the procedure for this client. Always have an extra pair of sterile gloves
available.
D. EQUIPMENT:
Packages of sterile gloves
E. PREPARATIONS
Assess the hands
F. PROCEDURE 5 4 3 2 1 REMARKS
1. Introduce yourself and verify the client’s
identity. Explain to the client what you
are going to do and why it is necessary,
and how the client can cooperate
2. Perform hand hygiene and observe other
appropriate infection control procedures.
3. Provide for client’s privacy
4. Open the package of sterile gloves
Place the package of gloves on a
clean, dry surface.
• Some 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 while
holding it or according to the
manufacturer’s instructions. If no
Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts,
Process, and Practice. 11th Edition. Pearson Education, Inc.
Page 1 of 2
Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES
tabs are provided, pluck the flap so
that the fingers do not touch the
inner surfaces
5. 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
nondominant hand. Touch only the
inside of the cuff.
• 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.
6. Put the second glove on the
nondominant hand.
• Pick up the other glove with the
sterile gloved hand, inserting the
gloved fingers under the cuff and
holding the gloved thumb closed to
the 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, and carefully pull the cuffs
up by sliding the fingers under the
cuffs.
7. Remove and dispose of used gloves
There is no special technique for
removing sterile gloves. If they are
soiled with secretions, remove them
by turning them inside out.
Perform hand hygiene
8. Document that sterile technique was
used in the performance of the
procedure.
G. EVALUATION
Conduct any follow-up indicated during your care of the client. Ensure that adequate
numbers and types of sterile supplies are available for the next health care provider.
Date & Time: ______________________
Clinical Instructor: __________________________
Source: Berman, A., Snyder, S., Frandsen, G. 2016. Kozier & Erbs Fundamentals of Nursing: Concepts,
Process, and Practice. 11th Edition. Pearson Education, Inc.
Page 2 of 2
