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Difficulty: HardAccident, Error, and Injury Prevention

A practical nurse has finished providing care for a client who requires both airborne and contact precautions. The nurse is currently wearing an isolation gown, gloves, and an N95 respirator. Arrange the steps for doffing the personal protective equipment (PPE) and exiting the area in the correct sequential order to prevent contamination.

  1. 1Remove and discard the gloves in the designated waste receptacle.
  2. 2Untie the isolation gown, pull it away from the shoulders, and roll it inside out.
  3. 3Exit the client's isolation room and verify that the door is completely closed.
  4. 4Remove the N95 respirator by carefully handling only the elastic head straps.
  5. 5Perform thorough hand hygiene using soap and water or an alcohol-based hand sanitizer.

Answer

The correct sequence is to first remove the gloves, then remove the gown, exit the client's room, remove the N95 respirator in the hallway, and finally perform hand hygiene.
Established infection control and safety protocols dictate that the most contaminated items (gloves and gown) must be removed first while the nurse is still inside the isolation room. Because the client is on airborne precautions, the nurse must remain protected against airborne particles until they have completely exited the room and the door is closed. Therefore, the N95 respirator is removed in the hallway or anteroom, followed by final hand hygiene to ensure complete decontamination.

Step-by-Step Solution

1
Remove and discard the gloves.
The most contaminated PPE is discarded safely.
Removing gloves first prevents the highly contaminated hands from spreading pathogens to the neck, face, or hair when untying the gown or reaching for the respirator.
2
Remove the isolation gown.
Contact precaution garments are fully removed inside the isolation environment.
The gown's front and sleeves are contaminated. Rolling it inside out traps the pathogens. This must be done inside the room before opening the door.
3
Exit the isolation room and close the door.
The nurse transitions to a clean environment while airborne protection is still active.
Airborne precautions require the door to remain closed to maintain negative pressure. The nurse must be safely outside the contaminated airspace before removing the respirator.
4
Remove the N95 respirator.
Respiratory protection is safely discarded without exposing the nurse to airborne particles.
Handling only the elastic straps prevents contamination of the hands from the front of the mask, which acts as a filter for pathogens.
5
Perform thorough hand hygiene.
Hands are completely clean and safe.
This final step ensures that any accidental contamination that occurred during the doffing process is eliminated before the nurse moves on to other tasks.

Key Concept

Personal Protective Equipment (PPE) doffing sequence for combined airborne and contact precautions.
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Topics

Accident, Error, and Injury Prevention

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