Nura 308 module 1
Donning PPE
Perform thorough hand hygiene before donning any PPE, ensuring to wash the front and back of hands, wrists, and between the fingers. Alcohol-based hand rub should be applied for at least seconds, or hands should be washed with soap and water for at least seconds, ensuring complete drying.
Isolation Gown: Put on the isolation gown, ensuring it fully covers the torso from the neck to the knees, with arms extending to the end of the wrists. The gown should wrap around the back and be secured at both the neck and the waist. Choose a gown appropriate for the anticipated level of fluid exposure.
Mask/Respirator: If wearing a regular surgical mask, remove the old mask before donning an N95 respirator. An N95 respirator is essential for airborne precautions.
N95 Respirator Fit and Eye Protection
N95 Respirator: Ensure you have the correct size of N95 respirator by checking the label, as proper fit is critical. Place the respirator over the nose and mouth, ensuring the flexible metal band is molded firmly over the bridge of the nose. The bottom elastic strap should be placed at the nape of the neck, and the top elastic strap at the crown of the head. Perform a fit check by inhaling sharply (should collapse slightly) and exhaling forcefully (should not feel air escaping from the edges) to confirm a tight seal. Adjust as necessary.
Eye Protection: Place your face shield or goggles over your face, ensuring it covers the eyes and extends to the sides of the face to prevent splash exposure. Adjust for a secure and comfortable fit.
Gloves: Don gloves last, ensuring that the cuffs of the gloves extend over the wrists of the isolation gown to create a continuous barrier.
Entry to Isolation Room
You may now enter the isolation room, as all necessary PPE has been donned correctly, creating a protective barrier.
Doffing PPE
When exiting the isolation room, the doffing process should be performed inside the room at the threshold to contain potential contaminants. The general principle is to remove the most contaminated items first, from areas with highest contamination to lowest, always performing hand hygiene between steps.
Isolation Gown and Gloves (Simultaneously):
First, break the tie at the waist of the isolation gown. Lean forward slightly and pull the gown away from your body, then break the neck tie.
As you pull the gown away, peel it down from the shoulders, turning it inside out. Simultaneously remove your gloves, touching only the inside surfaces of the gloves and gown with your bare hands. This action rolls the gown and gloves into a contaminated bundle, with the clean inner surface on the outside.
Place the rolled-up gown and gloves into a designated infectious waste container (e.g., a biohazard bin) within the patient room.
Perform thorough hand hygiene immediately after removing the gown and gloves, using either alcohol-based hand rub or soap and water.
Exit Isolation Room: After removing the gown and gloves and performing hand hygiene, you may exit the isolation room, moving from the high-contamination area to a lower-contamination area.
Face Shield/Goggles (Outside Room):
Outside the isolation room, carefully remove the face shield or goggles by lifting the headband or ear pieces up and over the head, avoiding touching the front surface of the item or your face/eyes.
If the item is reusable, place it in a designated receptacle for reprocessing (e.g., cleaning and disinfection). If not reusable, discard it in a waste container.
Perform hand hygiene after removing eye protection.
N95 Respirator (Outside Room):
Remove your N95 respirator by grasping the bottom elastic tie, pulling it up and over your head, and then grasping the top elastic tie and pulling it over your head. Avoid touching the front of the respirator or your face.
Discard the N95 respirator in a waste container.
Perform thorough hand hygiene immediately after removing the N95 respirator.
New Surgical Mask: Don a new regular surgical mask as indicated per universal masking guidelines or facility policy.
Exam Discussion: Gloves First vs. Gown First
During an ATI exam discussion, the sequence of doffing PPE was brought into question, with the exam suggesting gloves-first. However, participants universally discussed that a gown-first approach, rolling the gown and gloves into each other, seems more practical and significantly reduces the risk of self-contamination. The rationale for this consensus is that removing gloves separately before handling a potentially contaminated gown could expose bare hands to infectious material on the gown. Therefore, the practical viewpoint, aligning with current CDC guidelines and emphasizing contamination control, leans toward removing the gown and gloves in tandem, inside out, to minimize contact with soiled