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Difficulty: HardStandard and Transmission-Based Precautions

After completing morning care for a client placed in a negative-pressure isolation room due to a primary varicella-zoster infection, a practical nurse (PN) prepares to leave the room. The PN is currently wearing disposable gloves, a protective gown, and an N95 respirator. Place the following steps for removing personal protective equipment (PPE) and exiting the area in the correct chronological order.

  1. 1Remove the soiled gloves by grasping the outside of one glove at the wrist and peeling it off.
  2. 2Untie the gown and pull it downward from the shoulders, turning it inside out and rolling it into a bundle.
  3. 3Exit the negative-pressure isolation room and ensure the door closes completely.
  4. 4Remove the N95 respirator by lifting the bottom elastic strap over the head, followed by the top strap.
  5. 5Wash hands thoroughly with soap and water or use an alcohol-based hand rub.

Answer

The correct sequence for doffing PPE in airborne precautions is: remove gloves, remove gown, exit the isolation room, remove the N95 respirator, and perform hand hygiene.
The Centers for Disease Control and Prevention (CDC) strictly mandates that PPE be removed in a specific sequence to prevent self-contamination. The most contaminated items (gloves) are removed first, followed by the gown. Because the client has an airborne illness (primary varicella-zoster), the N95 respirator must remain on until the nurse has exited the negative-pressure room and closed the door. Finally, hand hygiene is always the last step to ensure any accidentally transferred pathogens are eliminated.

Step-by-Step Solution

1
Identify the type of isolation precautions required for the client's condition.
Primary varicella-zoster (chickenpox) requires Airborne and Contact Precautions.
Understanding the required precautions dictates the specific PPE worn and the strict sequence for safe removal.
2
Determine the order of removal for PPE inside the isolation room.
Gloves are removed first, followed by the gown.
The most contaminated items are removed first. Gloves harbor the highest concentration of pathogens. The gown is removed next, rolling it inside out.
3
Identify the location for respirator removal.
The nurse must exit the negative-pressure room and close the door before removing the N95 respirator.
Removing the respirator inside the room would expose the nurse's respiratory tract to airborne droplet nuclei (varicella virus).
4
Determine the safe method for removing the respirator.
The bottom strap is removed first, followed by the top strap.
This technique prevents the contaminated front of the respirator from flipping forward and touching the nurse's face.
5
Determine the final step of the doffing sequence.
Hand hygiene is performed immediately after removing the respirator.
Hand hygiene removes any transient flora or pathogens that may have contacted the hands during the PPE removal process.

Key Concept

Standard sequence for PPE removal (doffing) in Airborne and Contact Precautions
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Topics

Standard and Transmission-Based Precautions

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