Gown/
    				      Hand  	     Plastic 	       Eye
Procedure  			    Washing   Gloves  Apron   Mask  Protection           
                                                             

Bath (open lesions)			X  	X
Bath, routine (skin intact)  		X
Bleeding, pressure application to 
   control  				X  	X  	S  	*  	*
Blood glucose (capillary), testing  	X  	X
Breathing treatment, routine  		X  		S
Changing visibly soiled beds  		X  	X  	S
Cleansing, anal 			X  	X
Cleanup of:
     Incontinent patient (feces)  	X  	X  	S
     Incontinent patient (urine)  	X  	X
     Spills of blood/body substances  	X  	X  	S
     Surfaces contaminated by blood/
        body substances  		X  	X  	S
CPR    					X  	X
CVP measurement  			X  	X
Decubitus care   			X  	X
Dialysis, peritoneal:
     Initiation of acute treatment  	X  	X  	S  	*  	*  
     Performing an exchange		X  	X  	S  	*  	*
     Termination of acute treatment  	X  	X  	S  	*	*
     Setting up tubing to cycler  	X
     Dismantling tubing from cycler  	X  	X  	S  	*  	*	
     Addition of medications to 
        dialysate solution  		X 
     Discarding peritoneal drainage  	X  	X  	S  	*  	*
     Irrigation of peritoneal catheter  X  	X  	S  	*  	*
     Specimen collection  		X  	X
     Tubing change  			X  	X  	S  	*  	*
     Skin care (catheter site)  	X  	X    		X  	X
     Assisting with insertion of acute 
        peritoneal catheter 
        (outside sterile field)  	X  	X  	S  	*  	*
     Accidental disconnection from 
        cycler (wash hands immediately 
        after exposure)  		X
Dressing change, burn  			X  	X  	S
Dressing removal/change for 
   wounds with little or no drainage  	X  	X
Dressing removal/change for 
   wounds with large amount of 
   drainage				X  	X  	S
Emptying drainage receptacles, 
   including suction containers, 
   urine receptacles, bed pans, 
   emesis basins  			X  	X  	S  	*  	*
Emptying wastebaskets  			X  	X
Enema    				X  	X  	S
Fecal empaction, removal of  		X  	X
Fecal incontinence, placement of and 
   emptying bag  			X  	X  	*
Feeding patient 		 	X
Gastric lavage   			X  	X  	S
Intravenous/intraarterial:
     Initiation   			X  	X
     Termination  			X  	X
     Tubing change at hub of catheter  	X  	X
Irrigation:
     Foley   				X  	X
     Vaginal   				X  	X  	S
     Wound   				X  	X  	S  	*  	*
Medication administration:
     Eye, ear, and nose drops  		X  	X
     Intramuscular/subcutaneous  	X  	X
     Intravenous:
          Direct or into hub of 
             catheter/HeplockR  	X  
          Piggyback  			X
     Oral, nurse administered:
          Handed to patient  		X
          Placed in patient's mouth 
             by nurse  			X  	X
     Rectal/vaginal suppository  	X  	X
     Topical medication to intact 
         skin  				X
     Topical medication to lesion  	X  	X
Nasogastric tube, insertion/
   irrigation  				X  	X  	S  	*  	*
Oral/nasal care  			X  	X
Ostomy care, irrigation and teaching  	X  	X  	S
Oxygen:
     Draining of tube condensate  	X  	S
     Placing of cannula or mask  	X
Perineal cleansing  			X  	X
Physical assessment  			X
Pleur-evacR change  			X  	X  	*
Postmortem:
     Care   				X  	X 	 S
     Transportation of body in shroud  	X
Pulse oximetry   			X
Shaving   				X  	X
Sitz bath   				X
Specimen collection (blood, stool, 
   urine, sputum, wound) 		X  	X
Suctioning:
     Nasotracheal or endotracheal  	X  	X  	S  	*  	*
     Oral/nasal   			X  	X
Temperature, rectal 	 		X  	X
Trach care (suctioning and cleansing 
   of cannula)  			X  	X  	S  	* 	*
Traction   				X
Tube feeding   				X
Urine/stool testing  			X  	X
Vital signs (oral temperature, pulse, 
   respiration, blood pressure)  	X
Washing hair   				X
Wound packing   			X  	X  	S
Assisting with:
     Central line insertion/
        venesectomy (cut down)  	X  	X
     Cervical cauterization  		X  	X
     Chest tube insertion  		X  	X  	S  	*  	*
     Chest tube removal  		X  	X  	S  	*  	*
     Colonoscopy, flexible 
        sigmoidoscope  			X  	X
     Incision and drainage of 
        abscess  			X  	X  		*
     Intubation/extubation  		X  	X  	*  	*  	*
      Invasive procedures (lumbar 
         puncture, bone marrow 
         aspiration, paracentesis, 
         liver biopsy, outside sterile 
         field  			X  	X
     Joint/nerve injection  		X  	X
     Lesion biopsy/removal  		X  	X
     Pelvic exam and Pap smear  	X  	X
     Tracheostomy tube change  		X  	X    		*  	*