Appendix A – Hand Hygiene and Vital Signs Checklists

Checklists

Checklist for Handwashing

1. Use the checklist below to review the steps for completion of “Hand Hygiene With Soap and Water.”
   

   Steps

   Disclaimer: Always review and follow agency policy regarding this specific skill.

   1. Remove jewelry according to agency policy; push your sleeves above your wrists.
   2. Turn on the water and adjust the flow so that the water is warm. Wet your hands thoroughly, keeping your hands and forearms lower than your elbows. Avoid splashing water on your uniform.
   3. Apply a palm-sized amount of hand soap.
   4. Perform hand hygiene using plenty of lather and friction for at least 15 seconds:
      • Rub hands palm to palm
      • Back of right and left hand (fingers interlaced)
      • Palm to palm with fingers interlaced
      • Rotational rubbing of left and right thumbs
      • Rub your fingertips against the palm of your opposite hand
      • Rub wrists
      • Repeat sequence at least 2 times
      • Keep fingertips pointing downward throughout
   5. Clean under your fingernails with disposable nail cleaner (if applicable).
   6. Wash for a minimum of 20 seconds.
   7. Keep your hands and forearms lower than your elbows during the entire washing.
   8. Rinse your hands with water, keeping your fingertips pointing down so water runs off your fingertips. Do not shake water from your hands.
   9. Do not lean against the sink or touch the inside of the sink during the hand-washing process.
   10. Dry your hands thoroughly from your fingers to wrists with a paper towel or air dryer.
   11. Dispose of the paper towel(s).
   12. Use a new paper towel to turn off the water.
   13. Dispose of the paper towel.

Checklist for using Hand Sanitizer

1. Use the checklist below to review the steps for completion of “Hand Hygiene With Alcohol-Based Hand Sanitizer.”

Steps

Disclaimer: Always review and follow agency policy regarding this specific skill.

1. 1. Gather supplies (antiseptic hand rub).
   2. Remove jewelry according to agency policy; push your sleeves above your wrists.
   3. Apply enough product into the palm of one hand and enough to cover your hands thoroughly, per product directions.
   4. Rub your hands together, covering all surfaces of your hands and fingers with antiseptic until the alcohol is dry (a minimum of 20-30 seconds):
   5. Rub hands palm to palm
   6. Back of right and left hand (fingers interlaced)
   7. Palm to palm with fingers interlaced
   8. Rotational rubbing of left and right thumbs
   9. Rub your fingertips against the palm of your opposite hand
   10. Rub your wrists
   11. Repeat hand sanitizing sequence a minimum of two times.
   12. Repeat hand sanitizing sequence until the product is dry.

Checklist for Vital Signs

(See “Blood Pressure” chapter for Manual Blood Pressure Checklist)

1. Knock, enter the room, greet the patient, and provide for privacy.
2. Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
3. Perform hand hygiene and clean the stethoscope before approaching the patient.
4. Ask the patient their name and date of birth for the first identifier and verify wristband while the patient is stating information. Then use one of the following for the second identifier:
   • Scan wristband
   • Compare name/DOB to MAR
   • Ask staff to verify patient (LTC setting)
   • Compare picture on MAR to patient
5. Explain the procedure to the patient; ask if they have any questions.
6. Obtain temperature using correct technique in Celsius. Inform instructor if temperature is out of range. Normal range: 98.6 F or 37 C.
7. Obtain accurate pulse using radial artery. Inform instructor if pulse is out of range. Normal range for a pulse in an adult: 60-100 with regular rhythm.
8. Obtain accurate respiratory rate over 60 seconds. Inform instructor if respiratory rate is out of range. Normal range for respiratory rate in an adult: 12-20.
9. Obtain oxygen saturation reading (SpO2) using a pulse oximeter. Inform instructor if SpO2 is out of range. Normal range for SpO2: 94-100%.
10. Ensure safety measures when leaving the room:
    • CALL LIGHT: Within reach
    • BED: Low and locked (in lowest position and brakes on)
    • SIDE RAILS: Secured
    • TABLE: Within reach
    • ROOM: Risk-free for falls (scan room and clear any obstacles)
11. Perform hand hygiene and clean the stethoscope.
12. Follow the agency policy for following up on vital signs outside of normal range.
13. Document vital signs.