6.3 PPE & Transmission-Based Precautions

From Standard Precautions to Transmission-Based Layers

Standard precautions protect you for everyday care. Transmission-based precautions add extra barriers when a resident is known or suspected to have an infection that spreads in a particular way. On the Wisconsin CNA knowledge exam, Infection Control items often ask which PPE to wear, which isolation type matches a scenario, or what to do when entering and leaving a room with a posted sign. On the skills exam, one full task packages isolation PPE with urinary drainage bag emptying and hand washing.

Remember the hierarchy:

1. Always use standard precautions.
2. Add contact, droplet, and/or airborne precautions as posted and ordered.
3. Never invent isolation categories — follow the sign, care plan, and nurse direction.

Personal Protective Equipment (PPE) Basics

PPE only works if it is selected correctly, donned before exposure, used without self-contamination, and removed carefully with hand hygiene afterward.

Donning (Putting On) PPE — Clean Order

Facilities may publish a specific sequence. A widely taught, exam-friendly order for full PPE is:

1. Hand hygiene
2. Gown — fully cover torso; tie neck and waist so the back is closed
3. Mask or respirator — secure; for N95, perform a seal check if trained
4. Eye protection (goggles or face shield) if required
5. Gloves last — extend gloves over the gown cuffs so no skin shows at the wrist

Why gloves last? Gloved hands will touch the environment and the resident; if gloves go on first, you contaminate them while tying a gown. Cuffs must be covered so microbes do not travel up the wrist.

Isolation Cart Habits

• Read the isolation sign before entering.
• Gather all supplies needed so you do not bounce in and out.
• Keep a clean area on the cart for unused PPE.
• Do not take charts, personal phones, or clean communal items into the room if policy forbids them — use facility communication methods.
• Dedicate equipment (BP cuff, stethoscope, gait belt) to the isolation room when required, or disinfect thoroughly between residents.

Doffing (Removing) PPE — Contaminated Outside

The outside of used PPE is contaminated. The goal of doffing is to remove items so that dirty surfaces do not touch your face, clean clothing, or clean hands.

A common safe sequence (confirm with current facility skill sheet):

1. Remove gloves first (most contaminated). Grasp outside of one glove, peel inside-out; hold removed glove in the still-gloved hand; slide fingers under the remaining glove at the wrist (clean side) and peel it over the first glove; discard.
2. Hand hygiene if hands became contaminated or per local sequence (some sequences clean hands between steps).
3. Remove eye protection by the clean headband/ear pieces — not the front.
4. Remove gown — untie, pull away from neck/shoulders touching only the inside, turn inside-out, roll, discard.
5. Remove mask/respirator last — handle by ties/bands, not the front; discard or store reusable respirators per policy.
6. Hand hygiene immediately after all PPE is off (soap and water when required, including after the WI isolation + bag-empty skill).

Never snap gloves so that fluid sprays. Never touch your face with contaminated gloves. Never reuse single-use PPE.

Contact, Droplet, and Airborne Precautions

Contact Precautions

Used for: organisms spread by direct/indirect contact — MRSA (often), VRE, C. diff, scabies, draining wounds when indicated, many multidrug-resistant organisms.

CNA focus:

• Gown and gloves for all care and for contact with the resident/environment as posted
• Hand hygiene (soap and water for C. diff)
• Dedicated or thoroughly cleaned equipment
• Limit transport; cover wounds; notify receiving department
• Visitors may need instruction — direct questions to the nurse

Droplet Precautions

Used for: pathogens carried in large respiratory droplets — influenza, pertussis, some meningococcal exposures, certain pneumonias, and other facility-listed illnesses.

CNA focus:

• Surgical mask when entering the room / within close distance for care
• Resident wears a mask during transport if able and ordered
• Standard precautions still apply for body fluids
• Eye protection if splash risk from cough/suction
• Spatial separation and private room when available

Airborne Precautions

Used for: pathogens remaining infectious over longer distances in air — tuberculosis, measles, varicella (chickenpox), and other organisms per public-health guidance.

CNA focus:

• Negative-pressure / AIIR room when available; keep door closed
• N95 or higher respirator for staff who are fit-tested and assigned
• Limit entry to essential personnel; coordinate care to reduce trips
• Resident wears a surgical mask during necessary transport
• Follow facility TB/airborne protocols exactly — do not enter without proper respirator clearance

Some residents need combined precautions (e.g., contact + droplet). Wear everything the sign requires.

Isolation Room Care — Daily CNA Practice

Working in isolation is not “scary care”; it is disciplined care:

• Greet and identify the resident; explain why you are wearing PPE so dignity is preserved.
• Organize clean supplies before gloving for dirty tasks.
• Complete as much care as possible in one well-planned visit.
• Keep the call light within reach; isolation can increase loneliness — offer presence within PPE rules.
• Bag linen and trash per facility method at the doorway if required.
• Clean and disinfect high-touch surfaces with approved products (or notify housekeeping per role).
• Report missing PPE stock, broken door seals, or residents who refuse isolation measures to the nurse — do not argue and do not abandon precautions.

Mental Model: Protect the Hallway

Think of the room threshold as a border. Contaminated gloves, gowns, and equipment should not casually enter the clean corridor. Doff at the correct location (usually just inside the doorway or in an anteroom per facility design), perform hand hygiene, and only then handle clean documentation devices if allowed.

Wisconsin Skills Task: Isolation Gown & Gloves + Urinary Bag Empty

The Wisconsin Headmaster skills pool includes approximately this combined task (wording varies by handbook edition):

Don isolation gown and gloves → empty urinary drainage bag → measure and record output → doff PPE → hand washing.

Practice it as one continuous skill, not four separate ideas.

Performance Outline (Align to Current Handbook Key Steps)

1. Knock, introduce, identify resident, explain, provide privacy, wash hands if required at start per skill sheet, gather supplies (gown, gloves, graduate/measuring container, alcohol wipes if used, recording form/pen as allowed).
2. Don gown and gloves correctly before contacting the drainage system or resident environment as required.
3. Place paper towel or barrier on the floor if taught; position graduate below the bag without allowing the drain tip to touch the graduate sides or floor.
4. Open the drain, empty urine into the graduate without contamination, close and secure the drain, wipe the port if procedure requires, ensure bag remains below bladder level and tubing is not kinked or dependent loops full of urine.
5. Measure output at eye level in mL (or facility units), record accurately on the form with any required resident identifiers/time per skill instructions.
6. Dispose of urine in toilet; clean/rinse graduate per facility; remove barrier.
7. Remove gloves and gown without self-contamination; discard.
8. Wash hands with soap and water for the required technique (≥20 seconds, paper towel for faucet).
9. Complete comfort, call light, bed safety, and any final reporting steps listed on the skill sheet.

Output Measurement Pitfalls

• Reading the graduate from above or below eye level (parallax error)
• Forgetting to close the drain clamp/spout
• Allowing the spout to touch the graduate or toilet
• Raising the bag above the bladder during handling
• Recording the wrong number or forgetting units/time
• Contaminating clean areas while still gowned/gloved

Because this task fuses PPE + elimination + measurement + hand hygiene, it is a pure Infection Control skills marathon. Candidates who rush doffing or skip hand washing lose key steps even if the mL number was correct.

Putting PPE Questions to Bed on Test Day

When a knowledge stem mentions MRSA wound drainage or C. diff, choose contact barriers (gown/gloves) plus correct hand hygiene. When it mentions influenza-like illness and close care, add a mask. When it mentions TB, think airborne controls and respirator policy — not a casual surgical mask alone for staff in the room. When it describes skills isolation bag empty, visualize the full sequence: don → empty → measure/record → doff → wash.

Infection control is resident dignity plus scientific habit. Wisconsin expects both.