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?
Gown
Surgical mask
Goggles
Gloves
Standard Precautions should be used with which residents?
All residents, regardless of diagnosis
Only residents with a confirmed infection
Only residents in negative-pressure rooms
Only residents who are coughing
A resident has active pulmonary tuberculosis. Which combination is correct?
Surgical mask and a standard room
Gloves and gown only
Fit-tested N95 respirator and a negative-pressure room with the door closed
No special precautions needed once medication starts
While doffing PPE after caring for a resident, in what order should the first two items be removed?
Mask first, then gown
Gown first, then gloves
Goggles first, then mask
Gloves first, then goggles/face shield
Sections you finish are checked off in the contents.