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Difficulty: MediumStandard and Transmission-Based Precautions

A client diagnosed with Neisseria meningitidis and a concurrent vancomycin-resistant enterococcus (VRE) wound infection requires both droplet and contact precautions. The practical nurse has finished providing direct care and is standing near the doorway before exiting the client's room. Arrange the following steps for removing personal protective equipment (PPE) in the correct chronological order.

  1. 1Grasp the outside of one glove near the wrist and peel it off, turning it inside out.
  2. 2Remove the face shield by handling only the back of the headband or earpieces.
  3. 3Unfasten the gown ties, pull the gown down and away from the body, and roll it into a bundle.
  4. 4Remove the surgical mask by handling only the ties or elastic bands.
  5. 5Perform hand hygiene using an alcohol-based hand rub or soap and water.

Answer

The correct sequence for removing personal protective equipment is: remove gloves, remove face shield, remove gown, remove mask, and finally perform hand hygiene.
The Centers for Disease Control and Prevention (CDC) dictates a specific order for doffing PPE to minimize the risk of self-contamination. Because the outside of the gloves and the front of the gown and face shield are highly contaminated, the gloves are removed first. The face shield is removed next using the clean headbands. The gown is then carefully rolled off to contain contamination. The mask must be the last PPE item removed to maintain respiratory protection during the doffing process, followed immediately by thorough hand hygiene.

Step-by-Step Solution

1
Remove the soiled gloves.
The hands are freed from the most heavily contaminated protective item.
Gloves harbor the largest concentration of pathogens from direct client contact and must be removed first to prevent cross-contamination during subsequent steps.
2
Remove the face shield.
Eye protection is safely detached without bare hands touching the contaminated front.
The outside front of the face shield is contaminated by droplets; handling only the back straps protects the mucous membranes.
3
Remove the isolation gown.
The gown is bundled inside out and safely discarded in the appropriate receptacle.
The gown is removed next to prevent the transfer of VRE or other pathogens to the nurse's clothing.
4
Remove the surgical mask.
The respiratory protection is safely discarded by handling only the ties.
The mask protects the nurse from droplet exposure and must remain in place while the contaminated gown is disturbed and removed.
5
Perform hand hygiene.
The hands are completely decontaminated.
This is the final, essential step to eliminate any pathogens that may have transferred to the hands during the removal of the PPE.

Key Concept

Standardized sequence for doffing (removing) personal protective equipment (PPE)
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Topics

Standard and Transmission-Based Precautions

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