4.3 PPE & Transmission-Based Precautions
Key Takeaways
- Donning order is gown, then mask or respirator, then goggles or face shield, then gloves, with hand hygiene before donning.
- Doffing order is gloves, then goggles or face shield, then gown, then mask or respirator, with hand hygiene after, because doffing causes most self-contamination.
- Contact precautions add gown and gloves; droplet precautions add a surgical mask; airborne precautions add an N95 respirator and a special room.
- Choose PPE based on expected exposure, not on whether the resident looks sick.
- When the isolation sign or required PPE is unclear, the Florida CNA must ask the nurse before entering the room.
Personal Protective Equipment
Personal protective equipment (PPE) creates a barrier between the CNA and infectious material. Choose PPE based on the exposure you expect, not on how the resident looks. Standard precautions still apply underneath any added precautions.
Donning Order
Perform hand hygiene first, then put PPE on in this order:
- Gown.
- Mask or N95 respirator.
- Goggles or face shield.
- Gloves, pulled over the gown cuffs.
Doffing Order
Most self-contamination happens during removal, so the doffing order is the reverse logic, removing the dirtiest item first:
- Gloves.
- Goggles or face shield.
- Gown.
- Mask or respirator (remove after leaving the room for airborne precautions).
- Perform hand hygiene.
Transmission-Based Precautions
When standard precautions are not enough, the facility adds transmission-based precautions based on how the organism spreads.
| Category | Examples | Added CNA PPE And Setup |
|---|---|---|
| Contact | MRSA, C. diff, scabies | Gown and gloves; dedicated equipment; careful room exit |
| Droplet | Influenza, pertussis | Surgical mask; keep distance; respiratory etiquette |
| Airborne | Tuberculosis, measles, chickenpox | N95 respirator; negative-pressure room; ask the nurse before entry |
Isolation Room Habits
Before entering an isolation room, read the posted sign and gather every supply you need so you do not have to leave and return. Bring in only what is necessary. After care, remove PPE in the correct order, perform hand hygiene, and treat equipment as contaminated unless policy says otherwise. If the sign or the required PPE is unclear, ask the nurse before entering. Guessing can spread infection or expose the CNA.
What is the correct order for removing PPE after caring for a resident on contact precautions?
A resident is on airborne precautions for suspected tuberculosis. Which PPE does the Florida CNA need that is not required for droplet precautions?
A Florida CNA is unsure which PPE an isolation sign requires. What should the CNA do?