5.3 Personal Protective Equipment (PPE) and Standard Precautions
Key Takeaways
- Standard Precautions apply to EVERY resident regardless of diagnosis, treating all blood and body fluids except sweat as potentially infectious
- Donning order is gown, then mask/respirator, then goggles/face shield, then gloves last so the gloves cover the gown cuffs
- Doffing order is gloves first (most contaminated), then goggles, then gown, then mask, then hand hygiene
- Contact precautions (MRSA, C. diff, scabies) require gloves plus gown; droplet precautions (flu, pertussis) add a surgical mask within 3–6 feet
- Airborne precautions (TB, measles, chickenpox) require a fit-tested N95 respirator and a negative-pressure room with the door closed
- Gloves are never a substitute for hand hygiene; change them between tasks and between residents and wash hands after removal
Standard Precautions: The Baseline for Everyone
Standard Precautions are the infection-control practices a CNA uses with every resident, every time, regardless of diagnosis. They rest on one assumption: all blood, body fluids, secretions, and excretions (except sweat), non-intact skin, and mucous membranes may carry infectious agents, even if the resident looks perfectly healthy. You do not wait for a diagnosis to protect yourself and others.
Components of Standard Precautions
| Component | What the CNA Does |
|---|---|
| Hand hygiene | Before and after every contact and task |
| PPE | Gloves, gown, mask, eye protection matched to the task |
| Respiratory hygiene | Cover coughs/sneezes; offer masks to coughing residents |
| Sharps safety | Never recap needles; nurse disposes in sharps container |
| Environmental cleaning | Disinfect high-touch surfaces and shared equipment |
| Linen handling | Hold soiled linen away from uniform; minimal agitation; never on the floor |
| Equipment | Clean and disinfect shared items (BP cuff, lift) between residents |
PPE and When to Use It
| PPE | Use It For | Key Point |
|---|---|---|
| Gloves | Any contact with blood, fluids, mucous membranes, broken skin | Change between tasks AND between residents; wash hands after removal |
| Gown | Likely contact with fluids or soiled material; contact precautions | Ties at neck and waist; remove before leaving the room |
| Surgical mask | Droplet precautions; within 3–6 feet of a coughing resident | Cover nose AND mouth; replace when damp |
| N95 respirator | Airborne precautions (TB, measles) | Must be fit-tested; seal around nose and mouth |
| Goggles / face shield | Risk of splash or spray | Protect eyes fully; disinfect after use |
Trap: gloves do NOT replace handwashing — they can have micro-tears, and your hands are contaminated during removal. Always perform hand hygiene after doffing gloves.
Donning and Doffing: Order Is a Scored Critical Step
The sequence matters because PPE protects you only if it goes on clean and comes off without contaminating you. Memorize both directions; the INACE and CDC use the same order.
Donning (Putting On) — Gloves LAST
- Gown — open, slip arms in, tie at neck then waist.
- Mask or N95 respirator — secure over nose and mouth; mold the nosepiece.
- Goggles or face shield — position over the eyes and adjust.
- Gloves — last; pull the cuffs over the gown sleeves to leave no skin exposed.
Memory hook: "Gowns Make Greedy Geese" — Gown, Mask, Goggles, Gloves.
Doffing (Taking Off) — Gloves FIRST
- Gloves — most contaminated; peel glove-to-glove and skin-to-skin, never snap.
- Goggles / face shield — by the headband or earpieces; never touch the front.
- Gown — untie, pull away from the body, roll inside out, discard.
- Mask / respirator — by the ear loops or ties only; the front is dirty.
- Hand hygiene — immediately, every time.
Why the Order Works
| Rule | Reason |
|---|---|
| Gloves on last | They are the part most likely to touch the resident, so they go over everything |
| Gloves off first | They are the dirtiest item; removing them first protects the gown and skin |
| Mask off last | Protects your airway until you have left the contaminated zone |
| Hand hygiene always finishes | Catches any contamination that occurred during removal |
Worked example: before entering a C. diff resident's room you don gown, mask (if splash risk), then gloves. After care you peel gloves first, untie and roll the gown inside out, remove any eye protection, then — because alcohol does not kill C. diff — you wash with soap and water before leaving.
Transmission-Based Precautions and Illinois Requirements
When Standard Precautions are not enough, the nurse adds transmission-based precautions matched to how the pathogen spreads. Matching the disease to the right precaution and PPE is one of the most predictable INACE question types.
| Precaution | Spreads By | Classic Pathogens | Added PPE / Actions |
|---|---|---|---|
| Contact | Touch (direct/fomite) | MRSA, C. diff, scabies, draining wounds | Gloves + gown; dedicated equipment; private room preferred |
| Droplet | Large droplets ~3–6 ft | Influenza, pertussis, bacterial meningitis | Surgical mask within 3–6 ft; private room; mask resident during transport |
| Airborne | Tiny airborne particles | Tuberculosis, measles, chickenpox | N95 respirator; negative-pressure room; door kept closed |
High-yield distinctions:
- MRSA and C. diff are contact, NOT airborne — you need gloves and gown, not an N95.
- A surgical mask is enough for flu (droplet); an N95 is required for TB (airborne).
- C. diff adds the soap-and-water handwashing rule on top of contact precautions.
Illinois IDPH Facility Requirements
Illinois long-term care facilities must follow IDPH infection-control rules that shape your daily work:
- TB screening — baseline screening for new employees with ongoing risk assessment.
- Staff influenza vaccination — offered annually to all staff.
- Antibiotic stewardship and infection surveillance — tracking and reducing HAIs.
- Hand hygiene monitoring — routine compliance audits.
- Outbreak reporting — facilities report suspected outbreaks to IDPH promptly (commonly within 24 hours).
- COVID-19 protocols — testing, vaccination, and PPE per current IDPH guidance.
Scenario: you are assigned a resident with active pulmonary TB. The correct PPE is a fit-tested N95 respirator, the room must be negative pressure with the door closed, and you still apply Standard Precautions underneath. A surgical mask or an open door would be a failing answer.
When DONNING (putting on) PPE before entering an isolation room, which item is put on LAST?
Standard Precautions should be used with which residents?
A resident has active pulmonary tuberculosis. Which combination is correct?
While doffing PPE after caring for a resident, in what order should the first two items be removed?