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Difficulty: MediumStandard and Transmission-Based Precautions

A practical nurse (PN) has finished providing wound care for a client on Contact and Airborne precautions for a methicillin-resistant Staphylococcus aureus (MRSA) infection and active tuberculosis. The PN is wearing an N95 respirator, a face shield, an isolation gown, and gloves. In what order should the PN safely remove the personal protective equipment (PPE)? Arrange the actions in the correct sequence.

  1. 1Remove the gloves.
  2. 2Remove the face shield.
  3. 3Remove the isolation gown.
  4. 4Exit the client's room and close the door.
  5. 5Remove the N95 respirator.

Answer

The correct sequence for doffing PPE is to first remove the gloves, then the face shield, followed by the isolation gown. After these items are removed, the nurse must exit the room and close the door before finally removing the N95 respirator.
According to standardized CDC guidelines for doffing personal protective equipment (PPE), the most contaminated items must be removed first to prevent cross-contamination. Gloves are removed first, followed by the face shield or goggles (handled by the clean ear pieces or headbands). Next, the isolation gown is removed by unfastening the ties and rolling it inside out. When Airborne Precautions are in place, the nurse must then exit the isolation room and close the door before safely removing the N95 respirator in the hallway or anteroom.

Step-by-Step Solution

1
Identify and remove the most contaminated piece of equipment first.
The gloves are removed and discarded in the appropriate receptacle.
This prevents the transfer of pathogens from the hands to the face or hair during the removal of other PPE.
2
Remove face and eye protection.
The face shield is removed by handling only the clean headbands or ear pieces.
The front of the face shield is considered contaminated; handling only the back straps prevents hand contamination.
3
Remove the remaining body coverage.
The isolation gown is unfastened and rolled inside out into a bundle.
Rolling the gown inside out contains the MRSA pathogens present on the front and sleeves.
4
Maintain airborne protection while in the infectious environment.
The nurse exits the room and ensures the door is closed.
The N95 respirator must remain on while inside the airborne infection isolation room to filter aerosolized tuberculosis bacteria.
5
Remove respiratory protection in a safe area.
The N95 respirator is removed strictly outside the room and discarded.
This ensures the nurse is in a clean environment before exposing their respiratory tract to ambient air.

Key Concept

Standard CDC Sequence for Doffing PPE (Airborne and Contact Precautions)
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Topics

Standard and Transmission-Based Precautions

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