PPE and Transmission-Based Precautions

PPE and Transmission-Based Precautions

Standard Precautions are the floor under every resident interaction. Transmission-Based Precautions are additional layers used when a resident is known or suspected to have a pathogen that spreads by specific routes. On the Delaware Prometric written exam (Domain II, about 18% of the test) and in daily DHCQ-regulated facility practice, CNAs must read isolation signs, choose the right personal protective equipment (PPE), put it on and take it off without contaminating themselves, and understand basics of bloodborne pathogen safety.

PPE Selection Principles

PPE is chosen based on anticipated exposure and the precaution category posted by nursing/infection control—not based on personal preference or whether the resident “looks sick.”

Common PPE items:

If the sign says gown and gloves are required to enter, put them on before entry—even for a “quick” call-light answer. Partial compliance spreads pathogens to hallways, charting stations, and other rooms.

Donning (Putting On) PPE — Typical Order

Facilities teach a sequence aligned with CDC-style guidance. A widely taught donning order is:

1. Hand hygiene
2. Gown — fully cover torso; fasten neck and waist
3. Mask or respirator — secure fit; for N95, perform user seal check if trained/fit-tested
4. Eye protection (goggles or face shield) if required
5. Gloves — extend over gown cuffs

Always follow your facility’s posted sequence if it differs slightly, but exam questions usually match this logic: gown first among barriers, gloves last so they cover cuffs, mask before entering the exposure zone.

Prepare supplies outside the room when possible. Once you are gloved and gowned for contact isolation, you should not dig through clean supply drawers with contaminated gloves.

Doffing (Removing) PPE — Avoid Self-Contamination

Removal is when most self-contamination happens. A common doffing approach taught for many settings:

1. Gloves first (most contaminated) — remove without snapping; touch only the outside with glove-to-glove and inside with bare-skin-to-inside techniques as trained
2. Hand hygiene (or proceed carefully per facility sequence)
3. Gown — unfasten, pull away from body, fold contaminated outside inward, discard
4. Hand hygiene
5. Eye protection — remove from the back/sides, not the front
6. Mask/respirator — remove from ties/bands at the back; do not touch the front
7. Hand hygiene again

Some facilities use a doorway doffing zone: remove the most contaminated items before leaving the room, and remove the respirator after leaving an airborne room per policy. Read the sign. Never wear used isolation gowns into the clean nursing station or break room.

Practical Doffing Rules

• Treat the outside front of gown, gloves, mask, and goggles as contaminated.
• If gloves tear during care, remove them, perform hand hygiene, and replace.
• If you must adjust eyewear, do it in a way that does not transfer organisms to your eyes—ideally before contamination or with clean hands per situation.
• Dispose of PPE in the correct room or anteroom receptacles.

Contact Precautions

Contact Precautions prevent spread by direct or indirect touch. Typical pathogens/conditions emphasized in CNA training:

• MRSA (methicillin-resistant Staphylococcus aureus) wound or colonization when contact precautions are ordered
• C. difficile (often with soap-and-water hand hygiene and special sporicidal cleaning)
• Certain multidrug-resistant organisms (MDROs), scabies, and draining wounds when ordered

CNA Actions for Contact Precautions

• Gown and gloves to enter when the sign requires (including for brief contact with the environment).
• Use disposable or dedicated equipment when provided (blood pressure cuff, stethoscope cover policies).
• Limit movement of the resident from the room; if transport is required, nursing directs containment of drainage and PPE rules for transporters.
• Remove PPE carefully before exit; hand hygiene with soap and water when C. diff or policy requires.
• Do not share the resident’s towels, razors, or wound supplies with others.

Droplet Precautions

Droplet Precautions address pathogens spread by large respiratory droplets over short distances (generally about 3–6 feet, depending on guidance).

Examples often tested:

• Influenza
• Some forms of meningitis/pneumonia as identified by the care team
• Other droplet-spread respiratory illnesses per isolation order

CNA Actions for Droplet Precautions

• Wear a surgical mask on entry when required by the sign (and eye protection if splashes are likely).
• Place a mask on the resident during transport if tolerated and ordered.
• Teach/support cough etiquette: cover mouth, hand hygiene, tissues in wastebasket.
• Maintain spatial separation when possible; avoid sitting face-to-face unnecessarily during coughing episodes.
• Continue Standard Precautions for body fluids.

Droplets do not remain suspended indefinitely like true airborne particles; still, close unprotected face-to-face contact is how staff get infected.

Airborne Precautions

Airborne Precautions apply to pathogens that remain infectious over longer distances while suspended in air.

Classic example in CNA curricula:

• Tuberculosis (TB) — pulmonary or laryngeal TB when infectious
• Other airborne diseases as identified by public health/facility policy (for example, measles or varicella in some settings)

CNA Actions for Airborne Precautions

• Resident is typically in a negative-pressure airborne infection isolation room (AIIR) when available.
• Wear a fit-tested N95 respirator (or facility-specified respirator) before entry if you are assigned and cleared to enter.
• Keep the door closed.
• Limit entry to essential personnel; coordinate care to reduce door openings.
• Follow facility rules for removing the respirator after leaving the room.
• If you are not fit-tested or cleared, do not enter—notify the charge nurse so staffing can adjust.

CNAs do not decide when airborne isolation ends; that is a clinical and infection-prevention decision.

Combining Categories and Reading the Sign

Some residents require more than one category (for example, contact + droplet). Always follow the most complete PPE list posted. If a sign is missing or unclear, ask the licensed nurse before entering with supplies—do not improvise a lower level of protection.

Bloodborne Pathogens Basics

Bloodborne pathogens are microorganisms in human blood that can cause disease. The three most emphasized in healthcare training are:

1. Hepatitis B virus (HBV) — vaccine-preventable; facilities offer vaccination programs to employees with exposure risk.
2. Hepatitis C virus (HCV) — no routine vaccine; prevention relies on exposure control.
3. Human immunodeficiency virus (HIV) — causes AIDS; prevented with Standard Precautions and safe practices.

Exposure Control for CNAs

• Use Standard Precautions for all residents—status is often unknown.
• Wear PPE for blood and fluid contact; do not rely on “I know this resident.”
• Do not recap needles; use sharps containers; never reach into a sharps box.
• Cover your own non-intact skin with bandages before shifts when possible; report skin breaks that affect safe gloving.
• Clean blood spills with facility-approved procedures and PPE.
• If an exposure occurs (needlestick, blood splash to eyes/mouth, or blood on non-intact skin): immediate first aid per policy (flush eyes, wash skin), then report at once to the charge nurse/supervisor for evaluation and post-exposure follow-up. Do not wait until end of shift and do not hide the event.

Hepatitis B vaccination, training, and exposure reporting are worker-safety rights and responsibilities—not optional paperwork.

Psychosocial Care During Isolation

Isolation can frighten and lonely residents. Without breaking PPE rules:

• Explain in simple language why gown and mask are used: “These protect both of us.”
• Check in more often when possible so call lights are answered promptly.
• Offer reading materials, music, or window views as allowed.
• Avoid treating the resident as “dirty”; the pathogen is the problem, not the person.

Exam and Skills Alignment

Prometric Domain II items often ask which PPE for MRSA contact precautions, what to do after a blood splash, or the first step when leaving an isolation room. Skills testing grades hand hygiene and infection control as critical. The winning pattern is consistent: read the sign, select PPE, don before exposure, provide respectful care, doff without contaminating yourself, perform hand hygiene, and report exposures and equipment problems immediately.