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Difficulty: MediumStandard and Transmission-Based Precautions

After assisting a primary healthcare provider with an aerosol-generating procedure for a client with a novel respiratory virus requiring airborne, contact, and eye precautions, the practical nurse prepares to doff personal protective equipment (PPE). Arrange the following steps for safely removing the PPE in the correct chronological order.

  1. 1Remove gloves by grasping the outside of one glove at the palm and peeling it off.
  2. 2Remove the face shield by handling the back of the headband without touching the front.
  3. 3Unfasten the gown ties, pull the gown away from the neck and shoulders, and roll it inside out.
  4. 4Exit the client's negative-pressure room and close the door completely.
  5. 5Remove the N95 respirator by grasping the bottom elastic strap followed by the top strap.
  6. 6Perform thorough hand hygiene using an alcohol-based hand rub or soap and water.

Answer

The correct sequence is: remove gloves, remove face shield, remove gown, exit the room, remove the N95 respirator, and finally perform hand hygiene.
According to standard infection control guidelines, PPE must be removed in a manner that prevents self-contamination. The most contaminated items (gloves) are removed first. Eye protection and gowns follow. For airborne precautions, respiratory protection (N95) must remain in place until the nurse has exited the isolation room and closed the door. Hand hygiene is always the final step.

Step-by-Step Solution

1
Remove gloves.
Hands are freed from the most contaminated protective barrier.
Gloves are removed first to avoid contaminating the face, head, and uniform when removing other PPE.
2
Remove face shield.
Eye protection is taken off without touching the contaminated front surface.
The front of the shield is contaminated; removing it by the headband minimizes cross-contamination.
3
Remove gown.
The gown is bundled inside out and discarded in the appropriate receptacle.
Rolling the gown inside out traps contaminants, protecting the nurse's underlying uniform.
4
Exit the negative-pressure room.
The nurse is now in a clean hallway or anteroom.
Airborne pathogens remain contained in the isolation room, and the nurse must leave before removing respiratory protection.
5
Remove N95 respirator.
The respirator is safely removed by the straps and discarded.
Handling only the straps prevents hand contamination, and doing this outside the room prevents inhalation of airborne droplets.
6
Perform hand hygiene.
Pathogens transferred to the hands during the doffing process are eradicated.
Hand hygiene is the essential final step to break the chain of infection.

Key Concept

PPE Doffing Sequence for Airborne, Contact, and Eye Precautions
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Topics

Standard and Transmission-Based Precautions

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