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MOSBY'S TEXTBOOK FOR NURSING ASSISTANTS: Donning and Removing PPE and Transmission-Based Precautions

Donning PPE

  • Step 1: Follow Delegation Guidelines for Transmission-Based Precautions (refer to p. 245).

  • Step 2: Remove watch and all jewelry; roll up uniform sleeves.

  • Step 3: Practice hand hygiene.

  • Step 4: Put on a gown

    • Hold gown in front, unfold with back facing you, do not shake.

    • Insert arms through sleeves; gown should cover from neck to knees and wrists.

    • Tie neck strings, overlap back, snug fit over uniform.

    • Tie waist strings at back or side (not in front).

  • Step 5: Put on a mask or respirator

    • Pick up mask by upper ties; avoid touching the mask surface.

    • Place over nose and mouth.

    • Place upper ties above ears; tie at back middle of head.

    • Tie lower strings at back of neck; mask bottom under chin.

    • Pinch metal nose band; ensure top snug over nose; if wearing glasses, mask snug under glasses.

    • Ensure mask is snug over face and under chin.

  • Step 6: Put on goggles or face shield (if needed and not part of mask)

    • Place device over face/eyes; adjust to fit.

  • Step 7: Put on gloves; ensure wrists cover gown.

  • Step 8: Practice hand hygiene between steps if hands may be contaminated.

  • Step 9: Provide care while PPE is in use.

Removing PPE

  • Step 1: Method 1 — Gloves, goggles/face shield, gown, mask/respirator

    • Remove gloves first: touch only the glove surface; grasp glove at palm, inside-out along hand; remove one glove, hold with other gloved hand; slip fingers inside the other glove to remove second glove inside-out; discard.

    • Remove goggles/face shield: lift headband/ear-pieces from back; do not touch front; discard or follow policy for re-use.

    • Remove gown: untie neck then waist; pull gown down away from neck/shoulders; touch only inside of gown; turn inside-out as removed; fold/roll away from you; discard.

    • Remove mask: untie lower then upper strings; hold top strings and remove without touching front; discard.

  • Step 2: Method 2 — Gown and gloves, goggles/face shield, mask/respirator

    • Remove gown and gloves together carefully: grasp gown in front with gloved hands; pull away to break ties; touch only outside of gown; fold/roll inside-out; discard.

    • Remove goggles/face shield; discard or follow policy.

    • Remove mask as above (untie lower then upper, remove without touching front).

  • Step 3: Practice hand hygiene after removing all PPE.

Bagging and Biohazard Handling

  • Contaminated items go into leak-proof plastic bags labeled with the BIOHAZARD symbol (Fig. 17-7).

  • Biohazard waste includes items contaminated with blood, body fluids, secretions, or excretions.

  • Bag and transport linens per agency policy; do not over-fill; tie securely.

  • Trash and contaminated items go into containers labeled with the BIOHAZARD symbol; follow policy for bagging and transport.

  • Double-bagging may be required if the outside bag is wet or may be contaminated; use a cuff on a clean bag before placing dirty bag inside it (Fig. 17-8).

Collecting Specimens

  • Specimens (blood, body fluids, secretions, excretions) require biohazard specimen bags and proper labeling.

  • Wear gloves and other PPE as required; avoid contaminating outside of specimen container and outside of biohazard bag.

  • Procedure: Leave biohazard bag outside room; place container on paper towel inside room; collect specimen; secure lid; remove PPE and perform hand hygiene; place specimen in biohazard bag; discard paper towel; transport as per policy.

Transporting Persons on Transmission-Based Precautions

  • Patients may leave room for treatments or tests; follow agency procedures for transport.

  • Alert receiving area of isolation type and required PPE.

  • Have patient wear clean gown/ Pajamas and needed PPE; provide barriers (e.g., tissues, leak-proof bag for respiratory secretions).

  • Provide barriers and cover skin lesions or draining wounds; place an extra layer of sheets/pads as needed on stretchers/wheelchairs.

  • Do not allow others on the elevator; disinfect stretcher/wheelchair after use.

Focus on Communication: Meeting Basic Needs

  • The nurse explains the need for Transmission-Based Precautions and PPE to the patient, visitors, and staff; ensure understanding by asking questions.

  • Communication approach should avoid language that shames or tempts stigma.

  • Be careful with statements that imply blame, e.g.,

    • "How did you get that?"

    • "What were you doing?"

    • "I'm afraid to touch you."

    • "Don't breathe on me."

  • Always treat the person with respect, kindness, and dignity (focus on patient-centered care).