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Difficulty: Very hardStandard and Transmission-Based Precautions

A practical nurse is completing care for a client on airborne and contact precautions due to disseminated herpes zoster. The nurse is wearing an isolation gown, gloves, a face shield, and an N95 respirator. Assuming the nurse removes each piece of equipment separately, arrange the following steps for safely doffing the personal protective equipment (PPE) and exiting the room in the correct chronological sequence.

  1. 1Remove soiled gloves by grasping the outside of one glove at the wrist and peeling it off.
  2. 2Remove the face shield by reaching behind the head and lifting the clean headband over the head.
  3. 3Unfasten the gown ties, pull the gown away from the neck and shoulders, and roll it inside out into a bundle.
  4. 4Exit the client's negative-pressure isolation room and ensure the door is closed completely.
  5. 5Remove the N95 respirator by pulling the bottom elastic strap over the head, followed by the top strap.
  6. 6Perform hand hygiene using soap and water or an alcohol-based hand rub.

Answer

The correct sequence is: 1) Remove gloves, 2) Remove face shield, 3) Remove gown, 4) Exit the isolation room, 5) Remove N95 respirator, and 6) Perform hand hygiene.
According to standard CDC infection control guidelines, personal protective equipment (PPE) must be removed in a specific sequence to prevent self-contamination. The most contaminated items are removed first. Gloves are removed first, followed by the face shield (handled by the clean back straps), and then the gown (rolled inside out to contain pathogens). For airborne precautions, it is a critical safety requirement that the N95 respirator remains firmly in place until the nurse has safely exited the negative-pressure isolation room and closed the door. Finally, thorough hand hygiene is performed after all PPE is entirely removed.

Step-by-Step Solution

1
Remove gloves
Hands are freed from the most heavily contaminated PPE.
Gloves are typically the most contaminated items and must be removed first to prevent cross-contamination to the face or clean areas.
2
Remove face shield
Eye and face protection is safely discarded.
The face shield is removed next by handling only the clean back straps, protecting the nurse's face while still in the contaminated environment.
3
Remove gown
The gown is bundled inside out and discarded.
The gown is removed third. Rolling it inside out traps contact pathogens (like those from herpes zoster lesions) safely inside the bundle.
4
Exit the room
The nurse leaves the contaminated airborne environment.
The nurse must exit the negative-pressure room before removing respiratory protection to prevent inhalation of airborne infectious particles.
5
Remove N95 respirator
The respirator is discarded safely in the hallway.
Removing the N95 outside the isolation environment ensures the nurse's airway remains protected during the transition out of the room.
6
Perform hand hygiene
Any residual pathogens on the bare hands are eradicated.
Hand hygiene is strictly required as the final step of the doffing process to ensure complete decontamination.

Key Concept

PPE Doffing Sequence for Airborne and Contact Precautions
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Topics

Standard and Transmission-Based Precautions

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