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Difficulty: MediumStandard and Transmission-Based Precautions

A practical nurse has completed providing care for a client placed on airborne and contact precautions due to disseminated herpes zoster. The nurse is currently wearing an N95 respirator, an isolation gown, and gloves. In what order should the nurse perform the following actions to safely remove the personal protective equipment (PPE)? Arrange the steps from first to last.

  1. 1Remove the gloves by grasping the outside of one glove and peeling it off.
  2. 2Unfasten the gown ties and pull the gown away from the body, rolling it inside out.
  3. 3Perform hand hygiene and then exit the client's room.
  4. 4Remove the N95 respirator by handling only the elastic straps outside the room.
  5. 5Perform a final hand hygiene procedure before continuing with other tasks.

Answer

The correct sequence for doffing PPE in this scenario is: remove gloves, remove gown, perform hand hygiene and exit the room, remove the N95 respirator outside the room, and perform a final hand hygiene.
The Centers for Disease Control and Prevention (CDC) guidelines for removing PPE require the most contaminated items to be removed first. Gloves are removed initially, followed by the gown. Because the client requires airborne precautions, the N95 respirator must remain on until the nurse has exited the room and closed the door. Hand hygiene is essential both before exiting the room (to avoid contaminating the door handle) and after removing the respirator.

Step-by-Step Solution

1
Remove gloves
Gloves are safely discarded in the room.
Gloves are the most contaminated item and are removed first to prevent transfer of pathogens to the body or environment.
2
Remove the isolation gown
Gown is rolled inside out and discarded in the room.
The front and sleeves of the gown are contaminated. Removing it inside the room prevents spreading contact pathogens into the hallway.
3
Perform hand hygiene and exit the room
Hands are clean before touching the door.
This prevents contaminating the doorknob and the environment outside the isolation room.
4
Remove the N95 respirator outside the room
Respirator is safely removed and discarded.
Airborne pathogens can remain suspended in the air. The respirator must stay in place until the nurse is completely outside the contaminated airspace.
5
Perform final hand hygiene
Hands are completely sanitized.
Touching the straps of the respirator during removal may transfer small amounts of pathogens to the hands.

Key Concept

Personal Protective Equipment (PPE) Doffing Sequence for Airborne and Contact Precautions
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Topics

Standard and Transmission-Based Precautions

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