Personal Protective Equipment and Transmission-Based Precautions
Key Takeaways
- Select PPE based on the exposure you anticipate, not the resident's diagnosis alone: gloves for blood and body fluid contact, a gown for splashing onto clothing, and a mask with eye protection for splashes toward the face.
- Don PPE in the order gown → mask → goggles or face shield → gloves; doff in the order gloves → eye protection → gown → mask, with hand hygiene after removal.
- Contact precautions (C. difficile, MRSA) require gown and gloves; droplet precautions (influenza) require a surgical mask; airborne precautions (tuberculosis, measles, COVID-19 per facility policy) require a fit-tested N95 respirator and an airborne infection isolation room.
- An N95 respirator filters at least 95% of airborne particles and must be fit-tested; a surgical mask blocks droplets and splashes but does not protect against fine airborne particles.
- Isolation signage communicates the precautions required without revealing the resident's diagnosis, and the resident's dignity, privacy, and emotional needs remain the nurse aide's responsibility.
Choosing the Right PPE
Personal protective equipment (PPE) creates a barrier between you and infectious material. The rule is to select PPE for the exposure you anticipate during the task, not simply for the resident's chart diagnosis:
- Gloves — wear whenever you may touch blood, body fluids, secretions, excretions, mucous membranes, non-intact skin, or contaminated items. Change gloves between tasks on the same resident (for example, after perineal care before mouth care) and never wash or reuse disposable gloves.
- Gown — wear when your clothing or arms may be splashed or soiled: bathing, perineal care, emptying drainage bags, changing soiled linen, caring for draining wounds. Fasten at the neck and waist; sleeves should cover to the wrist.
- Mask — wear when there is risk of splashes or sprays to your mouth and nose, or as required for droplet and airborne precautions.
- Goggles or face shield — wear with a mask whenever sprays could reach your eyes (suctioning, wound irrigation, cleaning heavily soiled equipment). Personal eyeglasses are not adequate eye protection.
Donning and Doffing Sequence
The order matters because the goal is to put protection on over clean surfaces and take it off without touching the contaminated outside of each item.
Donning (putting on), in order:
- Gown — fasten neck and waist ties.
- Mask or respirator — secure ties or elastic bands at the middle of the head and neck; mold the nosepiece.
- Goggles or face shield — place over the eyes or face.
- Gloves — pull the cuffs over the gown's wrist cuffs so no skin is exposed.
Doffing (removing), in order — most contaminated items first:
- Gloves — peel away so the contaminated outside rolls inward; glove-to-glove then skin-to-skin.
- Goggles or face shield — remove by the headband or earpieces; the front is contaminated.
- Gown — unfasten ties, pull away from the neck and shoulders, turning the contaminated outside inward; roll into a bundle.
- Mask or respirator — remove by the ties or bands only, never touching the front; remove the mask after leaving the room for airborne precautions.
- Hand hygiene — immediately, every time. Hands are also cleaned any time contamination is suspected mid-removal.
On the Montana skills test, Don gown and gloves, empty a urinary drainage bag, measure and record output, then doff is one of the four mandatory first tasks every candidate may draw — it grades exactly this sequence and ends with a full embedded soap-and-water hand wash.
Transmission-Based Precautions
When a resident has a known or suspected infection that spreads by a specific route, the CDC adds transmission-based precautions on top of standard precautions. There are three categories, and the knowledge test expects you to match diseases to the correct category and PPE.
| Category | How It Spreads | Example Diseases | Room & PPE Requirements |
|---|---|---|---|
| Contact | Touching the resident or contaminated surfaces/equipment | C. difficile, MRSA, VRE, scabies, draining wounds, uncontrolled diarrhea | Private room preferred; gown and gloves on entry; dedicate equipment to that resident |
| Droplet | Large respiratory droplets from coughing, sneezing, talking — travel short distances | Influenza, pertussis (whooping cough), some meningitis, rubella | Private room preferred; surgical mask when working near the resident; mask the resident during transport |
| Airborne | Tiny particles that stay suspended and travel on air currents | Tuberculosis (TB), measles (rubeola), chickenpox (varicella), disseminated shingles; COVID-19 per current CDC and facility policy | Airborne infection isolation room (AIIR) with negative pressure, door kept closed; fit-tested N95 respirator for anyone entering; mask the resident during transport |
A category may be combined with contact precautions — for example, a resident with influenza and C. difficile diarrhea needs droplet plus contact precautions.
N95 Respirator vs. Surgical Mask
- A surgical mask fits loosely and is designed to block large droplets, splashes, and sprays — and to keep the wearer's respiratory secretions contained. It protects against droplet spread, not fine aerosols.
- An N95 respirator filters at least 95% of airborne particles and forms a tight seal against the face. It must be fit-tested to the individual wearer and seal-checked every time it is put on. N95s are required for airborne diseases such as tuberculosis. A surgical mask is never an acceptable substitute when airborne precautions are ordered.
Signage and Resident Dignity
A sign on the resident's door (or a caddy of supplies outside the room) tells staff and visitors what PPE is required without stating the diagnosis — that information is confidential. Nurse aides protect the isolated resident's dignity by explaining the precautions in simple terms, knocking and introducing themselves before entering, spending the same quality of time with the resident as with any other, and encouraging permitted visits and activities. Isolation commonly causes loneliness, anxiety, and depression; reporting withdrawal or sadness to the nurse is part of infection-control care too.
Equipment and Visitor Basics
Whatever goes into an isolation room should stay there: use dedicated stethoscopes, blood-pressure cuffs, and thermometers, and disinfect any item that must be shared before it touches the next resident. Take only what you need into the room so you do not have to carry contaminated extras back out. Visitors are taught by the nurse which PPE to wear and must perform hand hygiene when leaving; if you see a visitor enter without the required protection, alert the nurse rather than confronting the family yourself.
A resident has active pulmonary tuberculosis. Which protection must the nurse aide wear to enter the room?
Which is the correct order for putting on (donning) full personal protective equipment?
A resident with influenza is placed on droplet precautions. What should the nurse aide do when the resident must be transported to the radiology department?