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Difficulty: HardStandard and Transmission-Based Precautions

A practical nurse (PN) has finished providing morning care and changing the bed linens for a client diagnosed with both *Rubella* and *Norovirus*. As the PN prepares to leave the isolation room, which sequence of actions is correct?

  1. Remove the gloves and gown inside the client's room, exit the room, remove the surgical mask, and immediately wash hands with soap and water.Answer
  2. B
    Remove the gloves and gown inside the room, perform hand hygiene with an alcohol-based hand rub, exit the room, and remove the surgical mask.
  3. C
    Remove the gown, gloves, and N95 respirator inside the room, then perform hand hygiene using an alcohol-based hand sanitizer.
  4. D
    Exit the room wearing all personal protective equipment, remove the surgical mask, gown, and gloves in the hallway, and wash hands with soap and water.

Answer

The correct sequence is to remove the gloves and gown inside the client's room, exit the room, remove the surgical mask, and then immediately wash hands with soap and water.
The client requires Contact Precautions for *Norovirus* and Droplet Precautions for *Rubella*. To prevent cross-contamination, contact personal protective equipment (gown and gloves) must be removed inside the patient's room. Droplet protective equipment (the surgical mask) should be removed after exiting the room. Because *Norovirus* is an enteric pathogen that is resistant to alcohol-based hand rubs, hand hygiene must be performed using soap and water rather than sanitizer.

Step-by-Step Solution

1
Identify the transmission-based precautions required for the specific pathogens.
*Norovirus* requires Contact Precautions with enhanced enteric hand hygiene. *Rubella* requires Droplet Precautions.
Pathogen-specific protocols dictate the type of personal protective equipment (PPE) worn and the exact method of hand hygiene required.
2
Determine the correct location for removing Contact Precaution PPE (gown and gloves).
Gowns and gloves must be removed inside the client's room before exiting.
Removing contaminated contact PPE outside the room spreads pathogens to the clean hallway environment.
3
Determine the correct location for removing Droplet Precaution PPE (surgical mask).
The surgical mask must be removed after exiting the client's room and closing the door.
Removing the mask inside the room exposes the nurse's respiratory tract to airborne droplets still suspended in the patient's immediate environment.
4
Select the appropriate hand hygiene method based on the pathogens present.
Hands must be washed with soap and water.
Alcohol-based hand rubs lack efficacy against non-enveloped enteric viruses like *Norovirus*. Mechanical friction with soap and water is required to physically remove the viral particles from the skin.

Key Concept

Combined Contact and Droplet Precaution Doffing Sequence
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Topics

Standard and Transmission-Based Precautions

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