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Zorluk: ZorInfection Control and Hospital-Acquired Conditions

A 34-year-old physician completes the daily physical examination of a patient hospitalized with disseminated varicella-zoster virus (VZV) infection. The patient is housed in a negative-pressure airborne infection isolation room. The physician is wearing appropriate personal protective equipment (PPE), including an N95 respirator, a face shield, a disposable fluid-resistant gown, and non-sterile gloves. The physician now prepares to exit the room.

Arrange the following steps for doffing the personal protective equipment in the correct chronological sequence according to standard infection control and patient safety guidelines.

  1. 1Remove gloves and gown, taking care to roll the gown inside-out.
  2. 2Perform intermediate hand hygiene inside the patient room.
  3. 3Remove the face shield by grasping the strap behind the head.
  4. 4Exit the negative-pressure patient room and close the door.
  5. 5Remove the N95 respirator outside the room and perform final hand hygiene.

Cevap

The correct sequence is to first remove the most contaminated items (gloves and gown), perform hand hygiene, remove the face shield, exit the room, and finally remove the N95 respirator outside the room followed by final hand hygiene.
The established CDC infection control protocol for doffing Airborne and Contact precautions dictates removing the highest-risk items first (gloves and gown). Hand hygiene is performed immediately to ensure hands are clean before touching the face. The face shield is then removed by the clean straps. Because the patient has an airborne infection (disseminated VZV), the healthcare worker must exit the negative-pressure room and close the door before removing the N95 respirator to avoid inhaling suspended infectious particles. Final hand hygiene completes the sequence.

Adım Adım Çözüm

1
Remove gloves and gown, taking care to roll the gown inside-out.
Gross contamination is removed without transferring pathogens to the healthcare worker's scrubs or skin.
Gloves and gowns harbor the highest bioburden following a patient encounter and must be doffed first.
2
Perform intermediate hand hygiene inside the patient room.
Hands are decontaminated.
Prevents inadvertent self-inoculation of mucous membranes when reaching for facial PPE in the next step.
3
Remove the face shield by grasping the strap behind the head.
Eye protection is safely discarded without touching the contaminated front surface.
The front of the shield is considered contaminated; the back strap is considered clean.
4
Exit the negative-pressure patient room and close the door.
The healthcare worker transitions to a clean, non-infectious hallway.
Respiratory protection must remain in place as long as the worker is in the contaminated airborne environment.
5
Remove the N95 respirator outside the room and perform final hand hygiene.
The doffing process is safely completed.
Removing the N95 in the hallway ensures no airborne particles are inhaled, and final hand hygiene clears any residual contamination from handling the respirator straps.

Anahtar Kavram

During PPE doffing, items are removed in order from most contaminated to least contaminated. For airborne precautions, respiratory protection (N95) must strictly remain on until the healthcare worker has exited the negative-pressure environment.
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Infection Control and Hospital-Acquired Conditions

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