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Difficulty: HardStandard and Transmission-Based Precautions

A client with confirmed rubeola and a severe Clostridioides difficile infection requires a linen change. Before crossing the threshold of the negative-pressure isolation room, the practical nurse must don the necessary personal protective equipment (PPE). Arrange the donning steps in the correct chronological order.

  1. 1Perform thorough hand hygiene using plain soap and water at a sink.
  2. 2Put on a disposable, fluid-resistant isolation gown and secure the ties at the neck and waist.
  3. 3Apply a fit-tested N95 respirator, secure the elastic bands, and perform a user seal check.
  4. 4Secure a face shield over the eyes and face, adjusting the headband for a proper fit.
  5. 5Don clean gloves and extend the cuffs completely over the wrists of the isolation gown.

Answer

The correct sequence for donning the required PPE is to first perform hand hygiene with soap and water, followed by putting on the isolation gown, applying the N95 respirator, securing the face shield, and finally donning the gloves.
Following the standardized CDC sequence for donning PPE is essential to prevent self-contamination and ensure maximum barrier protection. The presence of Clostridioides difficile requires hand hygiene with soap and water, as alcohol-based rubs are ineffective against its spores. After hand hygiene, the gown is applied first as the foundational barrier. The N95 respirator is applied next to establish a secure seal against the face to protect against airborne rubeola. The face shield follows, resting over the respirator to protect the eyes from splashes. Finally, gloves are applied last so their cuffs can be pulled securely over the gown sleeves, ensuring continuous coverage.

Step-by-Step Solution

1
Wash hands with soap and water rather than an alcohol-based sanitizer.
Hands are cleansed of pathogens, including resilient C. difficile spores.
Hand hygiene must occur before handling clean PPE. Soap and water are mandatory because alcohol sanitizers are ineffective against C. difficile spores.
2
Put on the fluid-resistant gown and fasten all ties.
The nurse's uniform and torso are protected from infectious contact.
The gown is the largest PPE item and forms the base layer of protection, so it is applied immediately after hand hygiene.
3
Position the N95 respirator over the nose and mouth, secure it, and check the seal.
The nurse is protected against airborne rubeola particles.
The respirator must be applied directly against the skin to ensure an airtight seal before any eye protection is added.
4
Place the face shield over the eyes and face.
Mucous membranes are protected from potential fluid splashes.
Eye protection is placed over the respirator to ensure it does not interfere with the respirator's seal on the face.
5
Put on gloves, pulling the edges over the gown cuffs.
The hands and wrists are completely sealed against contact contamination.
Gloves must go on last to ensure they overlap the gown sleeves, preventing any exposed skin at the wrists.

Key Concept

Standardized CDC sequence for donning personal protective equipment (PPE) combined with organism-specific precautions
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Topics

Standard and Transmission-Based Precautions

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