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Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse has completed wound care for a client placed on airborne and contact precautions due to disseminated varicella-zoster. The nurse is currently wearing a disposable isolation gown, an N95 respirator, a face shield, and gloves. Arrange the following steps for removing the personal protective equipment (PPE) in the correct chronological order to prevent environmental contamination and self-exposure.

  1. 1Remove gloves by grasping the outside of one glove at the wrist and peeling it off.
  2. 2Remove the face shield by handling only the back of the headband or earpieces.
  3. 3Unfasten the gown ties and peel the gown away from the neck and shoulders, rolling it into a bundle.
  4. 4Exit the client's isolation room and close the door completely.
  5. 5Remove the N95 respirator by grasping the bottom strap followed by the top strap, avoiding the front.
  6. 6Perform thorough hand hygiene using an alcohol-based hand rub or soap and water.

Answer

The correct sequence for doffing PPE is to first remove the gloves, then the face shield, followed by the gown. The nurse must then exit the room and close the door before removing the N95 respirator, finishing the process with hand hygiene.
According to standardized infection control guidelines, the most contaminated items must be removed first to prevent self-contamination. Gloves are removed first, immediately followed by the face shield. The gown is then unfastened and rolled inside-out. Crucially for airborne precautions, the nurse must completely exit the negative pressure room and close the door before removing the N95 respirator to prevent inhalation of infectious particles. Finally, hand hygiene is always performed as the last step to ensure no pathogens remain on the hands.

Step-by-Step Solution

1
Remove gloves.
Hands are freed from the most contaminated PPE.
Prevents the transfer of highly concentrated pathogens to the head and neck area during the removal of other PPE.
2
Remove face shield.
Eye protection is safely taken off without contaminating the face.
Must be removed by the clean ear pieces or headband before the gown to avoid reaching behind the neck while wearing a contaminated gown.
3
Remove isolation gown.
Gown is rolled inside-out and discarded in the designated receptacle.
The front and sleeves are heavily contaminated; removing it by folding it inward prevents environmental and uniform contamination.
4
Exit the isolation room.
Nurse leaves the patient environment and ensures the door is sealed.
Airborne precautions require the respirator to remain securely on until the nurse is outside the negative pressure environment.
5
Remove N95 respirator.
Respirator is discarded safely outside the patient room.
Protects the nurse from inhaling airborne particles (varicella-zoster) that are still circulating inside the patient's room.
6
Perform hand hygiene.
Hands are completely decontaminated.
Removes any pathogens potentially transferred to the bare hands during the entire PPE doffing process.

Key Concept

Standard Sequence for Removing (Doffing) Personal Protective Equipment
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Topics

Standard and Transmission-Based Precautions

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