7.3 PPE (Skill 8) and Transmission-Based Precautions

7.3 PPE (Skill 8) and Transmission-Based Precautions

Quick Answer: Credentia Skill 8 — Donning and Removing PPE (Gown and Gloves) has one critical-element pair: before removing the gown, grasp the other glove at the palm and remove it, then slip ungloved fingers under the remaining cuff and pull that glove off inside-out. Donning is unfold, sleeves, neck, waist covering the back, gloves overlapping the gown cuffs. Then dispose of gloves, unfasten waist and neck, remove the gown without touching the outside, hold it away from the body and the floor, turn it inside-out, dispose, and wash hands. Transmission-Based Precautions add a package on top of Standard Precautions: contact (gown and gloves), droplet (mask), or airborne (N95 or respirator plus negative-pressure room).

Why Skill 8 and isolation share a section

Written items ask which PPE matches the organism. The skills test asks whether you can put a gown and gloves on without leaving your back open and take the gloves off without painting your bare wrist with the dirty palm. Those are the same job. Colorado Rule 1.11 already required infection control before client contact; isolation is that rule with a sign on the door.

/practice/co-cnaPractice questions with detailed explanations

Skill 8 — donning

1. Pick up the gown and unfold it. Do not shake it open over the clean supply cart.
2. Face the back opening. Put arms through each sleeve.
3. Fasten the neck opening.
4. Secure the waist so the back of your clothing is covered as much as possible. An open back is an open uniform.
5. Put on gloves.
6. Glove cuffs overlap gown cuffs. Bare wrist between glove and sleeve is a gap.

On a full isolation door you may also need a mask, goggles, or an N95. Skill 8 itself tests gown and gloves. In a real airborne room you still add the respirator before you walk in, and you still overlap the glove over the sleeve.

Skill 8 — doffing (critical elements live here)

Gloves come off before the gown. The dirty glove is the most contaminated surface on you.

1. CE: With one gloved hand, grasp the other glove at the palm and remove that glove.
2. CE: Slip fingers from the ungloved hand underneath the cuff of the remaining glove at the wrist, and remove it turning it inside out.
3. Dispose of the gloves in the designated waste container without contaminating yourself.
4. After gloves are off, unfasten the gown at waist and neck.
5. Remove the gown without touching the outside.
6. Hold the gown away from the body, do not touch the floor, turn it inward, keep it inside-out.
7. Dispose of the gown in the designated container without contaminating yourself.
8. Wash hands.

Glove-to-glove on the first glove, skin-to-inside-cuff on the second. If you grab the remaining glove on the dirty outside with a bare hand, you just did the opposite of the critical element. If you unfasten the gown while still gloved and drag the dirty glove across the neck tie onto your hair, you contaminated yourself. That is why the handbook says before removing the gown for the glove steps.

Donning order versus doffing order

When the door sign adds a mask or respirator, use a full sequence, not Skill 8 alone.

Never touch the front of a mask. Never wear isolation PPE into the hallway. Never wash and reuse gloves.

Transmission-Based Precautions

These packages are added to Standard Precautions. They are not a reason to skip hand hygiene.

C. difficile is contact plus soap-and-water hand hygiene plus a bleach-type disinfectant the facility assigns. Foam and a regular wipe leave spores behind.

A surgical mask is not an N95. Influenza is droplet. TB is airborne. Swapping those two PPE items is the classic written trap.

Isolation: leftovers and dedicated equipment

• Never reuse gloves between clients. One pair, one person, one task cluster. Change gloves between a dirty task and a clean task on the same person. Walk to the next room and you need a new pair.
• Dedicated equipment stays in the room: blood-pressure cuff, stethoscope, commode, thermometer. If an item must leave, it is cleaned and disinfected first.
• Tray leftovers from an isolation room do not go back onto the kitchen steam table. Follow facility policy: usually cover, bag, or discard in the room so used dishes are handled as dirty, not as leftover serving food.
• Read the door sign before you enter. If the N95 box is empty, do not improvise with a surgical mask for TB. Tell the licensed nurse.

Isolation is lonely. Keep the call light in reach, visit as often as PPE allows, and explain the gown in plain words. Infection control is not permission to ignore the person.

Colorado scenario

You are assigned two clients on a Fort Collins unit. Ms. Cho has a draining sacral wound and a contact-precaution sign. Mr. Hale has active pulmonary TB in a negative-pressure room. A float CNA says, "Gown and glove for both, same pair, then carry Ms. Cho's leftover soup back to the kitchen so it isn't wasted."

Ms. Cho is contact: gown and gloves, dedicated equipment, Skill 8 removal — palm grasp, then bare fingers under the remaining cuff, inside-out, gown off without touching the outside, wash. Her leftover tray is handled as isolation dirty, not as a second serving.

Mr. Hale is airborne: you need a fit-tested N95 and a closed negative-pressure door, not the same pair of gloves and not a surgical mask. You doff gloves and gown in the room or anteroom; the respirator comes off after you leave, by the straps. You never wear those gloves into Ms. Cho's room. Two diseases, two packages, two pairs of gloves, Standard Precautions under both.

Exam traps

• Pulling both gloves off by the fingertips so the dirty side stays out, or taking the gown off first.
• Leaving the back of the gown open, or leaving a bare wrist between glove and sleeve.
• Letting the gown touch the floor or your clean uniform on the way to the trash.
• Surgical mask for TB, or N95-only with no gown when the wound is pouring drainage.
• Reusing gloves from client to client, or walking leftover isolation food back to the steam table.
• Treating Transmission-Based Precautions as a replacement for Standard Precautions instead of an add-on.