Infection Control Department
PERFORMANCE/SKILLS CHECKLIST
HANDWASHING – ICP 05
NAME: _______________________________________ JOB NO: __________ UNIT: _______________
DATE OF ASSESSMENT: __________________ EVALUATOR: ________________________________
# SKILLS Met Not Met
1. Finger nails should be short and nail polish should be
removed.
2. Remove jewelries and watch.
3. Open the faucet. Wet hands with water. Hands should be in
downward position.
4. Apply 2-4 mL of liquid to hands and make lather.
Wash hands following these steps in 40-60 seconds.
5. Rub hands palm to palm
6. Right hand over left dorsum with interlaced fingers and vice
versa.
7. Palm to palm with fingers interlaced.
8. Backs of fingers to opposing palms with fingers interlocked.
9. Rotational rubbing of left thumb clasped in right palm and
vice versa.
10. Rotational rubbing, backwards and forwards with clasped
fingers of right hand in left palm and vice versa.
11. Rinse hands with water. Make sure that hands are still
placed downwards.
12. Dry hands thoroughly with a single use towel.
13. Use towel to turn off faucet.
Do hand-rub following these steps in 20-30 seconds.
1. Apply a palmful of alcohol gel in a cupped hand, covering all
surface
2. Rub hands palm to palm.
3. Right palm over left dorsum with interlaced fingers and vice
versa
4. Palm to palm with fingers interlaced.
5. Backs of fingers to opposing palms with fingers interlocked
6. Rotational rubbing of left thumb clasped in right palm and
vice versa
7. Rotational rubbing, backwards and forwards with clasped
fingers of right hand in left palm and vice versa
# KNOWLEDGE Met Not Met
1. Able to verbalize when to do handwashing and when to do
hand hygiene with alcohol rub.
2. Able to verbalize the duration in performing handwashing
and hand hygiene with alcohol rub.
Evaluator's Comment:
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Evaluator Staff Signature