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Difficulty: MediumStandard and Transmission-Based Precautions

A registered nurse has completed wound care for a client infected with Vancomycin-resistant Enterococcus (VRE) who also requires droplet precautions for a concurrent influenza infection. The nurse is currently wearing a disposable gown, gloves, a surgical mask, and a face shield. Arrange the steps for safely removing this personal protective equipment (PPE) in the correct chronological order.

  1. 1Remove and discard gloves.
  2. 2Remove the face shield by handling the head band or ear pieces.
  3. 3Unfasten the gown ties, pull it away from the neck and shoulders, and roll it into a bundle.
  4. 4Remove the surgical mask by grasping the bottom ties or elastics, then the top.
  5. 5Perform hand hygiene using an alcohol-based hand rub or soap and water.

Answer

The correct sequence for doffing PPE is: 1) Remove gloves, 2) Remove face shield or goggles, 3) Remove gown, 4) Remove mask or respirator, 5) Perform hand hygiene.
According to the Centers for Disease Control and Prevention (CDC), the standard doffing sequence is designed to minimize cross-contamination. Gloves are the most contaminated item and must be removed first. Next, eye protection is removed by the clean headbands, followed by the gown. The mask is removed last to ensure the respiratory tract remains protected while the rest of the PPE is doffed. Finally, hand hygiene is mandatory to eliminate any incidental contamination.

Step-by-Step Solution

1
Identify and remove the most contaminated equipment first.
Gloves are removed and discarded.
Prevents the nurse from using heavily contaminated hands to touch other areas of the body or clean PPE ties.
2
Remove eye protection.
The face shield is removed by the clean ear pieces or head band.
Protects the mucous membranes of the eyes and is removed without touching the contaminated front surface.
3
Remove the gown.
The gown is rolled inward into a bundle and discarded.
Rolling the gown inward traps pathogens inside, protecting the nurse's scrub uniform.
4
Remove respiratory protection.
The surgical mask is removed by the ties.
The mask is kept on until the end to maintain respiratory protection while removing other contaminated items.
5
Perform immediate hand hygiene.
Hands are washed or sanitized.
Eliminates any residual contamination that occurred during the doffing procedure.

Key Concept

Standard sequence for removing (doffing) personal protective equipment (PPE)
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Topics

Standard and Transmission-Based Precautions

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