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Difficulty: HardStandard and Transmission-Based Precautions

A registered nurse is preparing to exit the negative-pressure isolation room of a client diagnosed with disseminated varicella-zoster. The nurse is currently wearing a gown, an N95 respirator, a face shield, and gloves. Arrange the following steps for safely removing the personal protective equipment (PPE) and exiting the room in the correct chronological sequence.

  1. 1Grasp the outside of one glove with the opposite gloved hand and peel it off.
  2. 2Remove the face shield by handling only the clean headband or earpieces from the back of 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 room completely and ensure the negative-pressure door is closed.
  5. 5Remove the N95 respirator by lifting the bottom strap over the head, followed immediately 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.
The correct sequence for doffing PPE follows the core infection control principle of removing the most contaminated items first while maintaining continuous respiratory protection until safely outside an airborne isolation environment. The standard alphabetical mnemonic for doffing (Gloves, Goggles, Gown, Mask) dictates removing gloves first, followed by eyewear, then the gown. Crucially, for airborne pathogens, the nurse must exit the room before removing the N95 respirator, concluding the entire process with thorough hand hygiene.

Step-by-Step Solution

1
Remove gloves.
Hands are freed from the most contaminated component of the PPE.
Gloves harbor the highest concentration of contact pathogens and must be removed before touching the head or neck.
2
Remove the face shield.
Eye protection is safely discarded without contaminating the hands.
The back straps are considered clean, preventing cross-contamination from the contaminated front shield.
3
Remove the gown.
The gown is bundled inside-out and discarded in the designated room receptacle.
Rolling the gown inside-out prevents pathogens from transferring to the nurse's uniform.
4
Exit the client's room.
The nurse is securely in the hallway or anteroom.
Airborne pathogens (varicella-zoster) require maintaining a respiratory seal until safely outside the negative-pressure area.
5
Remove the N95 respirator.
The respirator is safely discarded outside the infectious environment.
Removing the bottom strap first prevents the mask from pivoting and contaminating the chest.
6
Perform hand hygiene.
Hands are completely decontaminated.
This guarantees that any accidental contamination during the doffing procedure is neutralized.

Key Concept

PPE Doffing Sequence for Airborne and Contact Precautions
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Topics

Standard and Transmission-Based Precautions

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