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Difficulty: Very hardStandard and Transmission-Based Precautions

A nurse has completed wound care for a client isolated on Airborne and Contact precautions due to active pulmonary tuberculosis and a Clostridioides difficile infection. The nurse is currently wearing an N95 respirator, a face shield, a disposable gown, and gloves. The gown and gloves are visibly soiled. Arrange the following actions for doffing personal protective equipment (PPE) and exiting the area in the correct chronological order.

  1. 1Remove and discard gloves by peeling them off from the wrist.
  2. 2Remove the face shield by handling only the clean headband.
  3. 3Unfasten the gown, pull it away from the body, and roll it inside out into a bundle.
  4. 4Exit the client's negative-pressure room and completely close the door.
  5. 5Remove the N95 respirator in the anteroom or hallway by handling only the elastic straps.
  6. 6Wash hands thoroughly with soap and water.

Answer

The correct sequence is: remove gloves, remove face shield, remove gown, exit the room, remove N95 respirator, and wash hands with soap and water.
The CDC guidelines dictate that PPE should be removed in an order that minimizes the risk of self-contamination. Gloves are the most contaminated and are removed first. The face shield is removed next by the clean headband, followed by the gown, which is rolled inside out. Because the patient requires Airborne precautions for tuberculosis, the nurse must leave the negative-pressure room and close the door before removing the N95 respirator. Finally, because the patient has C. difficile, hand hygiene must be performed using soap and water rather than alcohol-based hand rub.

Step-by-Step Solution

1
Remove gloves
Hands are freed from the most heavily contaminated PPE.
Gloves touch the client and environment most directly; removing them first prevents cross-contamination to the head and neck area.
2
Remove face shield
Face shield is discarded without contaminating the hands.
The headband is considered clean, allowing removal without transferring pathogens to the nurse's hands.
3
Remove gown
Gown is safely bundled and discarded.
Rolling the gown inside out contains the gross contamination (such as C. difficile spores) present on the exterior.
4
Exit the isolation room
Nurse is in a clean area (anteroom or hallway) with the door closed.
The N95 respirator must remain on while inside the room to protect against aerosolized Mycobacterium tuberculosis.
5
Remove N95 respirator
Respirator is discarded safely outside the patient environment.
Handling only the straps prevents contamination of the hands from the potentially pathogen-laden filter.
6
Wash hands with soap and water
Hands are thoroughly decontaminated.
C. difficile forms spores that are resistant to alcohol-based hand rubs; mechanical friction with soap and water is required.

Key Concept

Standard and Transmission-Based Precautions: PPE Doffing Sequence
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Topics

Standard and Transmission-Based Precautions

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