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Question

Difficulty: HardAccident, Error, and Injury Prevention

A practical nurse (PN) has finished providing care for a client on Airborne and Contact precautions for disseminated herpes zoster. Arrange the following actions for removing personal protective equipment (PPE) in the correct chronological sequence to prevent self-contamination.

  1. 1Grasp the isolation gown at the front and pull away to break the ties, rolling the gown and gloves together into a bundle.
  2. 2Remove the face shield by handling only the clean elastic headband from the back of the head.
  3. 3Exit the client's negative-pressure isolation room and ensure the door completely closes.
  4. 4Remove the N95 respirator in the hallway by grasping the bottom elastic strap followed by the top strap.
  5. 5Perform final hand hygiene using soap and water or an alcohol-based hand sanitizer.

Answer

The correct sequence is to first remove the gown and gloves together, then remove the face shield, exit the isolation room, remove the N95 respirator in the hallway, and finally perform hand hygiene.
Proper removal (doffing) of PPE is critical to prevent self-contamination and the spread of pathogens. According to standard guidelines for combined Airborne and Contact precautions, the nurse must first remove the most highly contaminated items (the gown and gloves) inside the client's room by peeling them off and rolling them inside-out. Next, the face shield is removed by touching only the clean back straps. Crucially, because the client requires Airborne precautions, the nurse must keep the N95 respirator on until they have completely exited the negative-pressure room and closed the door. Once in the hallway or anteroom, the N95 respirator is removed by the elastic straps to avoid touching the contaminated front. Finally, hand hygiene is performed as the absolute last step to eradicate any residual pathogens picked up during the doffing process.

Step-by-Step Solution

1
Remove the gown and gloves.
The most contaminated outer layers of PPE are safely discarded inside the room.
Gloves and gowns carry the highest bioburden; rolling them inside-out together contains the pathogens and protects the nurse's uniform.
2
Remove the face shield.
Eye protection is removed without touching the contaminated front.
Handling only the back straps prevents direct transmission of pathogens to the nurse's bare hands.
3
Exit the isolation room.
The nurse leaves the airborne-contaminated environment while still wearing respiratory protection.
The N95 respirator must remain sealed to the face until outside the negative-pressure room to prevent inhalation of suspended infectious particles.
4
Remove the N95 respirator.
The respirator is discarded in a safe area outside the room.
Removing the mask by its straps in the hallway prevents exposure to the airborne pathogen.
5
Perform hand hygiene.
Any residual pathogens on the hands are destroyed.
This is the universal final step to ensure safety and prevent cross-contamination to other clients, staff, or the environment.

Key Concept

The correct doffing sequence for Airborne and Contact precautions requires removing the most contaminated items (gown, gloves, face shield) inside the room, while retaining the N95 respirator until safely outside the negative-pressure environment.
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Topics

Accident, Error, and Injury Prevention

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