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Difficulty: Very hardStandard and Transmission-Based Precautions

After completing a wound dressing change for a client with disseminated herpes zoster, the practical nurse prepares to leave the airborne infection isolation room (AIIR). The nurse is currently wearing an N95 respirator, a face shield, an isolation gown, and gloves. What is the correct sequence for safely removing the personal protective equipment (PPE) and exiting the area?

  1. 1Remove the gloves by grasping the outside of one glove at the wrist and peeling it off.
  2. 2Remove the face shield by handling only the clean headband at the back of the head.
  3. 3Unfasten the gown ties, pull the gown away from the neck and shoulders, and roll it inside out into a bundle.
  4. 4Exit the airborne infection isolation room (AIIR) and close the door completely.
  5. 5Remove the N95 respirator by grasping the bottom elastic strap first, followed by the top strap.
  6. 6Perform thorough hand hygiene using an alcohol-based hand rub or soap and water.

Answer

The correct sequence is to first remove the gloves, then the face shield, followed by the gown. After removing these items, the nurse must exit the room and close the door. Once outside in the clean hallway, the nurse removes the N95 respirator and finally performs hand hygiene.
The correct sequence prioritizes removing the most contaminated items first (gloves), followed by the face shield and gown, all while remaining inside the client's room. Because the client has disseminated herpes zoster (requiring airborne and contact precautions), the N95 respirator must be kept on until the nurse has fully exited the negative-pressure room and closed the door. Furthermore, safely removing the N95 requires pulling the bottom strap first. Finally, hand hygiene is universally performed immediately after all PPE is removed.

Step-by-Step Solution

1
Identify the most contaminated items to remove first.
The gloves are removed.
Gloves have directly touched the client and environmental surfaces, making them the most contaminated item. Removing them first prevents transferring pathogens to the head or face during other doffing steps.
2
Protect the mucous membranes while maintaining body protection.
The face shield is removed by the back strap.
The traditional CDC doffing sequence dictates removing eyewear before the gown. Touching only the back strap ensures the hands remain clean.
3
Remove the remaining body protection.
The gown is untied, pulled away, and rolled inside out.
Rolling the gown inside out contains the contaminated front and sleeves, protecting the nurse's uniform and the environment.
4
Maintain the integrity of the airborne isolation environment.
The nurse exits the AIIR and closes the door.
To prevent inhalation of airborne particles (like aerosolized varicella-zoster virus), respiratory protection must remain firmly in place until the nurse is outside the negative pressure environment.
5
Remove respiratory protection safely.
The N95 respirator is removed using the straps, starting with the bottom strap.
Removing the bottom strap first prevents the contaminated front of the mask from falling against the nurse's body. Touching only the straps prevents hand contamination.
6
Eradicate any residual pathogens.
Hand hygiene is performed.
This is the universal final step of standard precautions to ensure hands are safe for the next client interaction.

Key Concept

Standard CDC PPE doffing sequence for combined Airborne and Contact precautions
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Topics

Standard and Transmission-Based Precautions

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