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Difficulty: Very hardStandard and Transmission-Based Precautions

A practical nurse is preparing to leave the room after completing care for a client in an airborne infection isolation room (AIIR). The client is diagnosed with active pulmonary tuberculosis and a vancomycin-resistant enterococci (VRE) infection of a lower extremity wound. The nurse is currently wearing an isolation gown, an N95 respirator, and clean gloves. Arrange the following steps for safely doffing the personal protective equipment (PPE) and exiting the area in the correct sequence.

  1. 1Grasp the outside of one glove near the wrist, peel it off, and discard both gloves in the designated receptacle.
  2. 2Unfasten the gown ties, pull the gown away from the neck and shoulders touching only the inside, and roll it into a bundle.
  3. 3Exit the airborne infection isolation room (AIIR) and ensure the door closes completely.
  4. 4Remove the N95 respirator by grasping the bottom elastic strap followed by the top strap, pulling them over the head.
  5. 5Perform hand hygiene using an alcohol-based hand rub or antimicrobial soap and water.

Answer

The correct sequence for doffing the required PPE is to first remove the gloves, followed by the isolation gown. The nurse must then exit the isolation room and close the door before removing the N95 respirator. Finally, the nurse performs thorough hand hygiene.
The Centers for Disease Control and Prevention (CDC) sequence for doffing PPE is carefully designed to prevent self-contamination. The most contaminated items, the gloves, are removed first. The gown is removed next, taking care to roll it inside out so the clean side is exposed. Because the client is on airborne precautions, it is critical that the N95 respirator remains in place until the nurse has fully exited the negative-pressure room and the door is closed. Once safely outside, the respirator is removed by the straps without touching the contaminated front surface. Finally, hand hygiene is performed to eliminate any microscopic pathogens transferred to the hands during the doffing process.

Step-by-Step Solution

1
Remove and discard gloves.
The nurse's hands are freed from the most contaminated protective barrier.
Gloves touch the client and the environment directly; removing them first minimizes the risk of contaminating other surfaces during the doffing process.
2
Remove and discard the isolation gown.
The gown is rolled inside out and safely placed in the infectious waste receptacle.
The front and sleeves of the gown are contaminated. Pulling it away by touching only the inside prevents pathogens from transferring to the uniform.
3
Exit the airborne infection isolation room.
The nurse is now in a clean environment, such as a hallway or anteroom.
The N95 respirator must remain on until the nurse has completely left the contaminated airborne environment to prevent inhalation of infectious droplet nuclei.
4
Remove the N95 respirator.
The respirator is removed and discarded without the nurse touching the front filter.
Handling only the elastic straps prevents contamination of the nurse's hands from the outer surface of the mask.
5
Perform hand hygiene.
The nurse's hands are cleansed of any residual pathogens.
Hand hygiene is the essential final step to ensure safety before continuing client care or documentation.

Key Concept

Proper PPE Doffing Sequence for Airborne and Contact Precautions
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Topics

Standard and Transmission-Based Precautions

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