4.3 PPE & Transmission-Based Precautions

Personal Protective Equipment

Personal protective equipment (PPE) creates a barrier between the CNA and infectious material: gloves protect the hands, a gown protects the uniform and arms, a mask protects the nose and mouth, and goggles or a face shield protect the eyes. Choose PPE based on the exposure you expect, not on how the resident looks. Standard precautions always apply underneath any added precautions.

Donning (Putting On) Order

Perform hand hygiene first, then put PPE on in this CDC order:

1. Gown — fasten at the neck and waist; it should cover the torso and arms.
2. Mask or N95 respirator — secure ties or loops; mold the nosepiece; cover nose, mouth, and chin.
3. Goggles or face shield — place over the eyes and adjust to fit.
4. Gloves — pull the cuffs over the gown cuffs so no skin shows.

Doffing (Removing) Order

Most self-contamination happens during removal, so doff by removing the dirtiest item first and touching only the inside surfaces:

1. Gloves (the most contaminated item).
2. Goggles or face shield (handle by the clean headband or earpieces).
3. Gown (peel away from the neck and shoulders, roll the contaminated outside in).
4. Mask or respirator (handle only the ties or loops; for airborne precautions remove it after leaving the room).
5. Perform hand hygiene.

A memory aid: you put gloves on last and take them off first, because they touch the most contamination.

Transmission-Based Precautions

When standard precautions alone are not enough, the facility adds transmission-based precautions chosen by how the organism spreads. The nurse posts a sign at the door; the CNA follows it.

The difference between droplet and airborne is the most-tested distinction: droplet needs only a surgical mask, while airborne needs a fit-tested N95 respirator and a special negative-pressure room.

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; items that enter may have to stay or be disinfected. After care, remove PPE in the correct order at the doorway, 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.

Residents in isolation are at high risk for loneliness and depression, so the CNA should still spend time, make eye contact, and explain that the precautions are about the germ, not the person.

Medical Versus Surgical Asepsis

Asepsis means being free of disease-causing germs. There are two levels:

• Medical asepsis (clean technique) reduces the number and spread of microorganisms. It includes hand hygiene, clean gloves, disinfection, and keeping clean and dirty items separate. Nearly all CNA infection-control work is medical asepsis.
• Surgical asepsis (sterile technique) removes all microorganisms, including spores, from an object or area — used for invasive procedures, sterile dressing changes, and catheter insertion. It uses sterile gloves and a sterile field and is generally performed by the nurse, not in the routine CNA scope. A CNA's job is to keep clean things clean and report when something sterile is contaminated.

Choosing PPE By Task, Not By Diagnosis

A common exam trap presents a resident who "looks fine" and asks whether PPE is needed. The answer depends on the task and the expected exposure, not the diagnosis or appearance:

• Gloves whenever contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated items is possible — emptying a bedpan, perineal care, mouth care, handling soiled linen.
• Gown when clothing or arms could be soiled or splashed — heavy incontinence care, a resident who is vomiting.
• Mask and eye protection when splashing or spraying of body fluid could reach the face — for example, emptying a large drainage container.

Gloves are changed and hand hygiene performed between residents and between a dirty and a clean task on the same resident; the same glove is never carried from one resident to another.

Caring For The Whole Person In Isolation

Transmission-based precautions can make residents feel rejected. The CNA reduces this by: explaining in plain language that the precautions target the germ, not the person; making eye contact and using the resident's name; keeping the call light within reach; and not rushing care. Reporting signs of depression or withdrawal in an isolated resident is part of the role.

Cleaning And Equipment

For contact precautions, use dedicated or disposable equipment when possible (a thermometer, blood-pressure cuff, and gait belt that stay in the room). Shared equipment is disinfected between residents with a facility-approved product, following the contact (wet) time on the label — a surface must stay visibly wet for the listed time to actually disinfect. Wiping it dry too soon is a common error. The CNA cleans from the cleanest to the dirtiest area and changes cloths as they become soiled, the same clean-to-dirty logic that governs handwashing and linen handling.