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PPE Usage

NCLEX Review Guide: Infectious Diseases, General Concepts, PPE Usage

Chain of Infection

Six Components of Infection Chain

  • Infectious agent - pathogenic microorganisms including bacteria, viruses, fungi, and parasites that can cause disease in susceptible hosts
  • Reservoir - the natural habitat where pathogens live, grow, and multiply, including humans, animals, and environmental sources
  • Portal of exit - pathway through which pathogens leave the reservoir, such as respiratory tract, GI tract, or broken skin
  • Mode of transmission - method by which pathogens travel from reservoir to susceptible host through contact, droplet, airborne, or vector routes
  • Portal of entry - pathway through which pathogens enter the susceptible host via mucous membranes, broken skin, or respiratory tract
  • Susceptible host - person who lacks immunity or resistance to specific pathogens due to compromised immune system or other risk factors

Key Points

  • Breaking any link in the chain prevents infection transmission
  • Hand hygiene is the most effective way to break the chain

Standard and Transmission-Based Precautions

Standard Precautions

  • Applied to ALL patients regardless of diagnosis, treating all body fluids (except sweat) as potentially infectious
  • Includes hand hygiene, appropriate PPE use, safe injection practices, and proper handling of contaminated equipment

Contact Precautions

  • Used for infections spread by direct or indirect contact with patient or contaminated surfaces
  • Examples: MRSA, VRE, C. difficile, scabies, impetigo, RSV in infants

Droplet Precautions

  • Required for pathogens transmitted through large respiratory droplets (>5 micrometers) that travel ≤3 feet
  • Examples: influenza, pertussis, pneumonic plague, meningococcal disease, mumps

Airborne Precautions

  • Necessary for diseases transmitted via small airborne particles (≤5 micrometers) that remain suspended in air
  • Examples: tuberculosis, measles, varicella (chickenpox), disseminated herpes zoster

Memory Aid: "My Chicken Varies in Tuberculosis"

Measles, Chickenpox (varicella), Varicella zoster, Tuberculosis = Airborne precautions

Personal Protective Equipment (PPE)

PPE Selection and Sequence

PPE Requirements by Precaution Type

PrecautionPPE RequiredRoom Type
StandardGloves, gown as neededRegular room
ContactGloves + gownPrivate room preferred
DropletSurgical mask + eye protectionPrivate room or cohort
AirborneN95 respirator + eye protectionNegative pressure room

    Donning PPE Sequence

  1. Perform hand hygiene
  2. Apply gown (tie at neck and waist)
  3. Apply mask or respirator
  4. Apply eye protection (if required)
  5. Apply gloves (over gown cuffs)

    Doffing PPE Sequence

  1. Remove gloves (avoid contaminating hands)
  2. Remove gown (roll inside out)
  3. Perform hand hygiene
  4. Remove eye protection
  5. Remove mask/respirator (handle by ties only)
  6. Perform final hand hygiene
Critical Alert: Hand hygiene must be performed before donning and after doffing PPE, and between glove changes

Clinical Scenarios

Scenario 1: C. difficile Patient Care

Patient with C. difficile colitis requires contact precautions. Nurse must wear gown and gloves for all patient contact. Alcohol-based hand sanitizer is NOT effective against C. diff spores - soap and water handwashing required.

Scenario 2: TB Patient Transport

Patient with active pulmonary TB needs chest X-ray. Patient must wear surgical mask during transport, and receiving department staff need N95 respirators. Transport should be minimized and receiving areas notified in advance.

Commonly Confused Concepts

Droplet vs. Airborne Transmission

CharacteristicDropletAirborne
Particle size>5 micrometers≤5 micrometers
Distance traveled≤3 feetRemains suspended in air
Mask requiredSurgical maskN95 respirator
Room requirementPrivate room preferredNegative pressure room

Memory Aid: "SPIDERMAN" for Contact Precautions

Scabies, Pediculosis, Impetigo, Diarrhea (C.diff), Eye infections, RSV (infants), MRSA, Abscess (draining), Necrotizing fasciitis

Quick Check Questions

Self-Assessment

  • I can identify the six components of the infection chain
  • I know the correct PPE for each type of precaution
  • I understand proper donning and doffing sequences
  • I can differentiate between droplet and airborne precautions
  • I know when to use soap and water vs. alcohol-based sanitizer

Common Pitfalls to Avoid

  • Don't confuse droplet and airborne - remember particle size and distance
  • Hand hygiene timing is critical - before and after PPE use
  • C. difficile requires soap and water, not alcohol sanitizer
  • N95 fit testing is required before use with airborne precautions

You're building the foundation for safe patient care! Master these infection control principles to protect your patients and yourself. Every precaution you take makes a difference in preventing healthcare-associated infections.

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