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Difficulty: Very hardStandard and Transmission-Based Precautions

While participating in a bedside chest tube insertion for a client on airborne and contact precautions, a practical nurse (PN) sustains a percutaneous injury from a contaminated scalpel. Visible blood splashes onto the PN's fluid-resistant gown and face shield. Which sequence of actions must the PN execute FIRST?

  1. Remove the gloves, wash the puncture site with soap and water at the in-room sink, systematically doff the face shield and gown inside the room, and retain the N95 respirator until after exiting into the hallway.Answer
  2. B
    Doff the blood-splashed gown and face shield immediately to prevent blood from soaking through to the uniform, remove the punctured gloves, and wash the hands before exiting the room.
  3. C
    Remove the gloves and wash the puncture site, then immediately exit the client's room to prevent further airborne exposure, doffing the contaminated gown, face shield, and N95 respirator in the hallway.
  4. D
    Remove the gloves, wash the puncture site with soap and water, doff the N95 respirator to prevent inhaling aerosolized blood, and remove the gown and face shield before opening the door.

Answer

The nurse must first remove the contaminated gloves to wash the puncture site, then remove the gown and face shield inside the room, and finally remove the N95 respirator after exiting the room.
Post-exposure protocol requires immediately removing the source of contamination (the punctured gloves) and washing the injury with soap and water. Because the client is on contact precautions, the contaminated gown and face shield must be removed inside the room to prevent environmental transmission. Because the client is on airborne precautions, the N95 respirator must remain completely sealed until the nurse has fully exited the room and closed the door.

Step-by-Step Solution

1
Address the immediate biological hazard by removing the punctured gloves.
The primary source of bloodborne contamination is separated from the nurse's skin.
Gloves are the most heavily contaminated item and must be removed before touching any other surface or PPE.
2
Wash the puncture site with soap and water at the in-room sink.
Pathogen load at the injury site is mechanically reduced.
Immediate cleansing with soap and water is the gold standard first-aid response for percutaneous bloodborne exposures.
3
Doff the face shield and fluid-resistant gown inside the client's room.
Contact precautions are maintained.
PPE contaminated with bodily fluids or contact-precaution organisms must never be worn into clean areas like hallways.
4
Exit the room, close the door, and then doff the N95 respirator.
Airborne precautions are maintained.
The respirator must remain securely sealed over the airway until the nurse is entirely out of the contaminated airborne environment.

Key Concept

Integration of Post-Exposure Prophylaxis (PEP) protocols with overlapping Airborne and Contact isolation standards.
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Topics

Standard and Transmission-Based Precautions

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