3.2 Personal Protective Equipment and Standard/Transmission-Based Precautions

Standard Precautions

Standard Precautions are infection-control practices applied to the care of every resident, every time, regardless of diagnosis or presumed infection status. They are based on the principle that blood and all body fluids, secretions, and excretions — except sweat — may contain infectious agents, whether or not a resident is known to be sick. Standard Precautions include hand hygiene, using personal protective equipment (PPE) whenever contact with body fluids is possible, safe handling of sharps, and covering coughs and sneezes.

Because it is impossible to know at any moment which residents are carrying an infectious agent, a nurse aide chooses PPE based on the task being performed, not on a resident's diagnosis. Gloves are worn for any contact with body fluids, mucous membranes, non-intact skin, or contaminated items. A gown is added when clothing might become soiled, such as during bathing, perineal care, or wound care. A mask and eye protection are added whenever splashing or spraying of a body fluid is possible, such as during suctioning or wound irrigation.

Donning and Doffing PPE

Donning (Putting On) Order

1. Gown — tied at the neck and waist, fully covering street clothes.
2. Mask — secured snugly over the nose, mouth, and chin.
3. Goggles or face shield — positioned over the eyes, and over the mask if one is worn.
4. Gloves — put on last, pulled up over the gown's cuffs so the wrists stay fully covered.

PPE is put on from cleanest item to dirtiest, ending with gloves last because the hands are about to make the most direct contact with the resident and any contaminated surfaces.

Doffing (Taking Off) Order

1. Gloves — removed first because they are typically the most contaminated item; peel them off inside-out without letting bare skin touch the outer surface.
2. Goggles or face shield — removed next, handled by the earpieces or headband rather than the front.
3. Gown — untied at the waist and then the neck, rolled with the contaminated side inward, and discarded without touching the outer surface.
4. Mask — removed last, handled only by the ties or ear loops, since it protected the airway throughout the entire task.
5. Hand hygiene — performed immediately after all PPE is removed.

Common Exam Traps

• Removing the mask or gown before the gloves, instead of gloves first
• Untying the gown at the neck while still wearing contaminated gloves, which spreads germs to the ties, neck, and hair
• Skipping hand hygiene after doffing because gloves were worn the whole time
• Touching the contaminated front surface of goggles, a face shield, or a mask while removing it

No PPE combination ever replaces hand hygiene. Whether a nurse aide is following Standard Precautions alone or an added Transmission-Based category, hands are washed or sanitized before gloves go on and again immediately after the full sequence of PPE comes off, since gloves reduce exposure during the task but cannot guarantee the skin underneath stayed completely germ-free.

Transmission-Based Precautions

Transmission-Based Precautions are used in addition to Standard Precautions — never instead of them — when a resident has, or is suspected of having, an infection that spreads by a specific route Standard Precautions alone don't fully control. There are three categories:

A frequent exam trap is confusing droplet and airborne precautions: a regular surgical mask is not sufficient protection against airborne diseases like TB or measles — those require a fit-tested N95 respirator because the particles are small enough to remain suspended in the air and travel well beyond a few feet. Some conditions require more than one category at once; chickenpox, for example, commonly requires both Airborne and Contact Precautions because the virus spreads through the air and through direct contact with fluid from the skin lesions. Transmission-Based Precautions are always layered on top of Standard Precautions — they never replace hand hygiene or the routine use of gloves for body-fluid contact.

Worked Example

Consider a resident on Contact Precautions for C. diff. Before entering the room, the nurse aide dons a gown and gloves over her uniform, in addition to Standard Precautions PPE. She provides perineal care, then removes her gloves first, followed by the gown, before performing hand hygiene with soap and water — not ABHR — because of the C. diff spores discussed earlier in this chapter. This single scenario ties together three separate exam topics: the Transmission-Based Precautions category, the correct doffing order, and the soap-and-water requirement for spore-forming organisms.