Republic of the Philippines

CAVITE STATE UNIVERSITY

Don Severino Delas Alas Campus
Indang, Cavite
COLLEGE OF NURSING

DONNING STERLIE GOWN, CLOSED GLOVING

Name_________________________________________ Yr and Sec___________ Date:______________

PROCEDURE DONE DONE WITH NOT REMARKS

ASSISTANCE DONE
1. Ensure observance of proper OR attire:
Personal hygiene
No abrasions or wounds on hands
Jewelries removed
Clean scrub suits, shoes, cap, and mask
2. Assess the surrounding environment.
3. Validate the Procedure: Confirm with the
circulating nurse the scheduled procedure.
4. Gather all necessary items. Double check the
packaging and expiration date.
5. Gather sterile drapes pack. Make sure that it is
sterile and uncontaminated.
6. Gently open the sterile pack using aseptic
technique to establish your sterile field.
7. Drop sterile items in the sterile field gently.
Observe meter distance from the field.
8. Perform surgical hand scrub*
9. Dry your hands using a towel/ grasp the gown and
pat dry hands on the lower part of the gown.
10. Grasp the neckline of the gown allow it fall open.
11. Slip both arms simultaneously in the armhole while
keeping hands inside the sleeves.
12. The circulating nurse will secure the ties at the
back.
13. With hands still inside the gown sleeves, open the
inner wrapper of the sterile gloves.
14. With your non dominant sleeved hand, place the
palm of the dominant-hand glove against the
sleeved palm of the dominant hand.
15. Grasp the glove cuff with your dominant, sleeved
thumb. With your non dominant hand, turn the cuff
over the end of the dominant hand and gowns cuff
16. While holding the glove and gown cuffs securely,
slowly extend the fingers into the glove.
17. With gloved dominant hand, repeat steps 15 and
16.
18. Interlock gloved fingers and secure fit.
TOTAL

Clinical instructor:_______________________
 Republic of the Philippines
CAVITE STATE UNIVERSITY
Don Severino Delas Alas Campus
Indang, Cavite
COLLEGE OF NURSING

GOWNING AND GLOVING THE SURGEON

Name_________________________________________ Yr and Sec___________ Date:______________

PROCEDURE DONE DONE WITH NOT REMARKS

ASSISTANCE DONE
1. Pick up a gown from the sterile pack. Step back
from the sterile field and let the gown unfold in
front of you.
2. Hold the gown at the shoulder seams with the
gown sleeves facing you.
3. Offer the gown to the surgeon. Be careful not to
touch anything but the sterile gown. The circulator
will tie the gown.
4. Pick up the right glove. With the thumb of the glove
facing the surgeon,.
5. Unfold the cuff of the glove. Place your fingers and
thumbs of both hands in the cuff of the glove and
stretch it outward, making a circle of the cuff.
6. Offer the glove to the surgeon. Inform the surgeon
which glove are you serving. Be careful that the
surgeons bare hand does not touch your gloved
hands.
7. Repeat the preceding step for the left glove.
TOTAL

Clinical instructor:_______________________