A nurse is caring for a patient with suspected tuberculosis in the emergency department. Which personal protective equipment (PPE) sequence demonstrates the correct donning procedure for airborne precautions?
The correct donning sequence starts with hand hygiene, followed by gown, mask, eye protection, gloves, and final hand hygiene check, ensuring minimal contamination risk for Ebola. Other sequences may compromise protection.
Core Nursing ExplanationKey Concept Analysis: This question tests the correct sequence for donning Personal Protective Equipment (PPE) for Airborne Precautions. The sequence is designed to protect the healthcare worker from infection while minimizing the risk of contaminating oneself or the environment. For airborne diseases like Tuberculosis (TB), the primary PPE is a N95 respirator or higher (mask), but a gown, gloves, and eye protection may also be needed based on the anticipated exposure to other body fluids. The core principle is to perform hand hygiene first, don from "clean to dirty," and end with gloves.
Answer Rationale: Option ③ is correct because it follows the CDC-recommended sequence for donning PPE when a gown is required. Key Point! The sequence is: 1. Perform hand hygiene (to start clean) → 2. Put on the gown (ties at the back) → 3. Put on the mask/respirator (secure ties, perform a fit check for N95) → 4. Put on eye protection (goggles or face shield) → 5. Put on gloves (extend over gown cuffs) → 6. Perform a final hand hygiene check (ensuring no skin is exposed and PPE is secure). The final hand hygiene step is a critical safety check before entering the patient's room.
Distractor Analysis:
Watch out for confusion! Option ① is incorrect because it omits the final, crucial hand hygiene check after donning all PPE. This check is a standard safety step.
Option ② is incorrect because it begins with the gown before performing initial hand hygiene. This risks contaminating the gown and the environment with pathogens from the nurse's hands.
Option ④ is incorrect for multiple reasons. It places hand hygiene in the middle of the sequence and puts the mask on before the gown. The correct principle is to put on items that tie at the back (like most gowns) before items that tie at the back of the head (like an N95 mask) to avoid contaminating the mask during gown tying.
Related Concepts: Remember that the doffing (removal) sequence is the reverse of donning, with hand hygiene between key steps to prevent self-contamination. The sequence for doffing is typically: Gloves → Hand hygiene → Gown → Hand hygiene → Eye protection → Mask → Final hand hygiene. The type of "mask" matters: for Droplet Precautions, a surgical mask is sufficient; for Airborne Precautions, an N95 respirator or PAPR (Powered Air-Purifying Respirator) is required.
Concept Summary Airborne Precautions (for TB, Measles, Chickenpox): Private room with negative pressure, N95 respirator for anyone entering.
CDC Donning Sequence (with Gown): Hand hygiene → Gown → Mask/N95 → Eye protection → Gloves → Final hand hygiene check.
Core Principle: Clean to dirty. Protect mucous membranes (eyes, nose, mouth) and non-intact skin.
Side-by-Side Comparison!
Precaution Type
Key Diseases
Required PPE (Beyond Standard)
Room Type
Airborne
Tuberculosis, Measles, Varicella
N95 respirator or PAPR
Negative pressure, AIIR*
Droplet
Influenza, Pertussis, Meningitis
Surgical mask
Private room or cohort
Contact
MRSA, VRE, C. diff
Gown & Gloves
Private room or cohort
*AIIR: Airborne Infection Isolation Room
Anatomy, Physiology & Pharmacology Points
The rationale for PPE is based on the chain of infection. For TB, the infectious agent (Mycobacterium tuberculosis) is transmitted via airborne droplet nuclei (very small particles that remain suspended in air). These particles are small enough (<5 microns) to bypass the natural filtration of the upper airways and reach the alveoli of the lungs, causing infection. The N95 respirator is designed to filter out at least 95% of these small particles.
Memory Tips
Donning Mnemonic: "Hands Get Most Easily Germy Check" (Hand hygiene, Gown, Mask, Eye protection, Gloves, Check/Hand hygiene).
Order Logic: Think "Tie things behind your back (gown) BEFORE you tie things behind your head (mask)."
High-Frequency NCLEX Topics
PPE sequence is a classic NCLEX topic. The exam tests both the correct order and the rationale behind it (infection control principles). You must know the differences between Standard, Contact, Droplet, and Airborne Precautions, including the specific PPE and room requirements for each.
Watch Out for Question Variations!
The NCLEX might ask:
1. Priority Action: "The nurse is about to enter the room of a patient with TB. Which action should the nurse take first?" (Answer: Perform hand hygiene).
2. Doffing Sequence: Provide the correct order for removing PPE.
3. PPE Selection: "Which PPE is required for a patient with rubella?" (Requires Droplet Precautions, so a surgical mask is sufficient unless splash is anticipated).
4. Error Identification: "The nurse dons gloves, then a gown. Which principle of infection control did the nurse violate?"
Nursing Clinical Practice GuideClinical Scenario: You are the triage nurse in the ED. A 45-year-old patient presents with a 3-week history of productive cough, night sweats, and unexplained weight loss. A chest X-ray is ordered and shows findings suspicious for pulmonary TB. The physician orders the patient to be placed in isolation immediately.
Nursing Intervention Strategy:
1Assessment & ActionImmediately place the patient in the Airborne Infection Isolation Room (AIIR). Inform registration to flag the chart. Place appropriate signage on the door.
2PPE DonningBefore entering the room to perform an initial assessment or obtain sputum samples, don PPE using the correct sequence as outlined. Key Point! Perform a user seal check every time you put on an N95 respirator to ensure a proper fit.
3Patient Care & EducationExplain the reason for isolation to reduce anxiety. Instruct the patient on proper respiratory hygiene/cough etiquette (cover mouth with tissue when coughing). Collect sputum specimens as ordered, ensuring the lid is secure.
4Doffing & Contamination ControlAfter leaving the room, remove PPE in the anteroom or immediately outside the door using the correct doffing sequence to prevent self-contamination. Dispose of all PPE in appropriate biohazard waste.
Patient Safety and Precautions:
- Key Point! Anyone entering the room must wear a fit-tested N95 respirator. PAPRs are used for staff who cannot be fit-tested or for prolonged procedures.
- Keep the door to the AIIR closed at all times to maintain negative pressure.
- Limit patient transport. If transport is necessary, the patient must wear a surgical mask.
1Hand HygieneUse alcohol-based rub or soap and water.
2GownFully cover torso from neck to knees, arms to end of wrists. Tie at neck and waist.
3N95 RespiratorPlace over nose, mouth, and chin. Fit flexible nose piece. Secure ties at crown of head and base of neck. Perform a user seal check (positive and negative pressure checks).
4Eye ProtectionPosition goggles or face shield over eyes and secure on head.
5GlovesExtend to cover wrist of gown.
6Final CheckVerify all PPE is secure, no skin or clothing is exposed. Sanitize hands again if needed before entering.
A Word from Your Senior Nurse
"Infection control isn't just a policy—it's your personal armor. In the rush of the ED, it's tempting to skip a step, but that's exactly when exposure happens. Mastering the 'dance' of donning and doffing PPE makes it second nature, protecting you, your colleagues, and your other patients. Remember, for TB, that N95 is non-negotiable. On the NCLEX, they love to test if you know the 'why' behind the order. It's always about creating a barrier from clean to contaminated. Think it through every time!"
Airborne Precautions — Infection control measures for diseases transmitted via airborne droplet nuclei (e.g., TB, measles). Requires a private negative pressure room and respiratory protection (N95 or PAPR).
N95 Respirator — A personal protective device that filters at least 95% of airborne particles. Must be fit-tested for each user to ensure a proper seal. Used for Airborne Precautions.
Chain of Infection — The sequence of events that allows an infection to spread: Infectious Agent, Reservoir, Portal of Exit, Mode of Transmission, Portal of Entry, Susceptible Host. PPE interrupts the mode of transmission.
Doffing — The procedure for safely removing PPE. The sequence is typically the reverse of donning, with careful hand hygiene between steps to prevent self-contamination.
Negative Pressure Room — An isolation room where air pressure is lower than the surrounding areas, causing air to flow into the room when the door is opened. This contains airborne pathogens within the room. Also called an AIIR.