Name:______________________________
Date:__________________________
Procedure 26-7
Using Sterile Transfer Forceps
Objective: The student, using the supplies and equipment listed below, will demonstrate
how to move sterile instruments and supplies within a sterile field, onto a sterile field, or
into a sterile gloved hand without contaminating.
.
Supplies: Transfer forceps, sterile tray set upon a Mayo stand, forceps, container 2/3 full
of Cidex or other sterilant, sterile 4 x 4 gauze package, instrument or supply pack for use
with sterile transfer forceps
Notes to the Student:
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Skills Assessment Requirements
Read and familiarize yourself with the procedure; complete the minimum practice
requirements. Document each MPR using proper charting technique. Complete each
procedure within a reasonable amount of time, with a minimum of 85% accuracy.
Name:______________________________
Date:__________________________
POINT VALUE
 = 3-6 points
 = 7-9 points
1. 
2. 
3. 
Open the 4 x 4 gauze package
using sterile technique and lay
it on the countertop or Mayo
stand.
Grasp the forceps handles,
keeping the tips together.
Remove the forceps vertically
from the container without
touching the sides.
Touch the forceps tips to the
gauze 4 x 4 to dry them. Do
not allow the forceps to touch
the sterile field.
Holding them vertically, pick
up and move an item from the
open pack to the sterile field.
4. 
To move a sterile item on the
sterile field, keep the forceps
vertical, pick up the item, and
lift it to the desired location
without touching the sterile
field.
Place the transfer forceps back
into the standing container
without touching the sides.
PRACTICE
TRIAL
GRADED
TRIAL
#1
GRADED
TRIAL
#2
NOTES:
Name:______________________________
Date:__________________________
Document: Enter the appropriate information in the chart below.
Grading
Points Earned
________
Points Possible
________
Percent Grade
________
27
27
 YES
 YES
 NO
 NO
 N/A
 N/A
(Points Earned/Points Possible)
PASS:
________
Instructor Sign-Off
Instructor:___________________________________________ Date:___________