# A nurse has just finished caring for a client in contact and droplet precautions. The nurse is preparing to doff personal protective equipment (PPE) before exiting the room. Place the following PPE removal steps in the correct CDC sequence from first (1) to last (5).

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=368317&lang=en  
> language: en  
> subject: Standard/Transmission-Based Precautions/Surgical Asepsis  
> category: SIPC

## Question

A nurse has just finished caring for a client in contact and droplet precautions. The nurse is preparing to doff personal protective equipment (PPE) before exiting the room. Place the following PPE removal steps in the correct CDC sequence from first (1) to last (5).

Remove the surgical mask or N95 respirator by handling only the ties or elastic, never the front

Perform hand hygiene with soap and water or alcohol-based hand rub

Remove the gloves by grasping the outside of one glove with the other gloved hand and peeling off

Untie the gown ties and pull the gown away from the neck and shoulders, rolling it inside out

Remove the goggles or face shield by handling the headband or earpieces, not the front

## Explanation

CDC standard PPE doffing sequence prevents self-contamination by removing items in order from most contaminated to cleanest, with hand hygiene last. Step 1 — gloves: hands always touch contaminated surfaces, so gloves come off first using the outside-glove-to-outside-glove technique then bare-hand to inside-glove. Step 2 — goggles or face shield: front is contaminated, so handle only the headband or earpieces. Step 3 — gown: untie and pull away from neck and shoulders, rolling the contaminated outside inward. Step 4 — mask or N95: handle only the ties or elastic; the front filters contaminated air. Step 5 — hand hygiene: soap and water or alcohol-based rub before leaving the room. Hand hygiene is also performed between any contamination event during the sequence.

## In-depth explanation

CDC PPE Doffing Sequence
Most contaminated → cleanest → hand hygiene

Step-by-Step
1. Gloves — outside-to-outside, then bare-hand-to-inside
2. Goggles or face shield — handle headband or earpieces only
3. Gown — untie, pull away, roll inside out
4. Mask or N95 — handle ties or elastic only, never the front
5. Hand hygiene — soap and water or alcohol-based rub

Why This Order
- Gloves are most contaminated — direct patient contact
- Front of goggles is contaminated by spray
- Gown front and sleeves contact patient bedding and surfaces
- Mask front filters airborne contamination
- Hand hygiene closes the cycle before touching the environment

Common Errors
- Touching the front of any PPE during removal
- Skipping hand hygiene at the end
- Removing the mask first (heaviest contamination but covers airway)
- Reaching across face

N95 Specifics
For airborne precautions, exit the room and close the door before removing the N95.

NCSBN Theme
SIPC — Standard precautions and PPE.

## Clinical scenario

Scenario
Nurse exiting a contact and droplet precautions room.

PPE Worn
- Gloves
- Goggles or face shield
- Gown
- Surgical mask

Required
5 doffing steps in CDC order from first (1) to last (5).

Principle
Most contaminated removed first, hand hygiene last.

## Key concepts

- **CDC PPE doffing sequence** — Standard CDC removal order: (1) gloves, (2) goggles or face shield, (3) gown, (4) mask or respirator, (5) hand hygiene. Each item is handled by the cleanest portion (ties, headband, inside surface). Hand hygiene is performed between any contaminated contact and after the final mask removal. For airborne precautions, leave the room and close the door before removing the N95 to avoid releasing aerosolized particles.
- **Levels of transmission-based precautions** — Standard precautions apply to all clients. Beyond standard: contact (gown plus gloves; e.g., MRSA, C. difficile), droplet (surgical mask within 6 feet; e.g., influenza, pertussis), airborne (N95 plus negative-pressure room; e.g., TB, measles, varicella). Combined precautions when multiple routes apply (e.g., COVID-19 = contact plus droplet plus eye protection plus airborne for aerosol-generating procedures).
- **Hand hygiene priority** — WHO Five Moments for Hand Hygiene: (1) before patient contact, (2) before aseptic task, (3) after body fluid exposure risk, (4) after patient contact, (5) after contact with patient surroundings. Soap and water for visible soiling, C. difficile, norovirus; alcohol-based rub adequate for routine. Always perform after PPE removal regardless of glove use.

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