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Difficulty: HardStandard and Transmission-Based Precautions

After performing open tracheostomy suctioning on a client diagnosed with pulmonary tuberculosis and methicillin-resistant Staphylococcus aureus (MRSA) of the sputum, a registered nurse prepares to leave the negative-pressure isolation room. Arrange the following steps for removing personal protective equipment (PPE) in the proper chronological sequence.

  1. 1Remove the gloves by grasping the outside of one glove with the opposite gloved hand.
  2. 2Remove the face shield by handling the clean headband 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.
  4. 4Exit the negative-pressure room and ensure the door closes completely.
  5. 5Remove the N95 respirator by grasping the bottom strap followed by the top strap.

Answer

The correct sequence is: Remove gloves, remove face shield, remove gown, exit the room, and finally remove the N95 respirator.
The standard sequence for doffing personal protective equipment follows an alphabetical mnemonic: Gloves, Goggles (Face Shield), Gown, and Mask (Respirator). Furthermore, for a client on airborne precautions, the respirator must be removed only after exiting the negative-pressure room and closing the door.

Step-by-Step Solution

1
Remove the gloves.
The most contaminated items are removed first.
Prevents cross-contamination of the face, hair, and uniform during the remainder of the doffing process.
2
Remove the face shield.
Eye protection is safely removed by touching only the clean back strap.
The front of the shield is contaminated; it must be removed before the gown to avoid contaminating the face with the gown.
3
Untie and remove the gown.
The gown is rolled inside-out and discarded in the room.
The gown is removed before exiting to ensure contact pathogens are contained within the isolation environment.
4
Exit the negative-pressure room.
The nurse transitions to a clean environment.
The door must be closed to maintain the negative-pressure seal before respiratory protection is compromised.
5
Remove the N95 respirator.
The final piece of PPE is safely removed.
Airborne precautions dictate that respiratory protection must remain in place until the nurse is entirely out of the contaminated airspace.

Key Concept

Personal Protective Equipment (PPE) Doffing Sequence and Airborne Precautions
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Topics

Standard and Transmission-Based Precautions

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