Using PPE

The charge nurse confronts a new nurse about not wearing gloves into a client's room. The client is not on transmission-based precautions. How does the new nurse best respond?

"Can you show me the hospital policy for when to wear gloves?" - When there is any doubt, the facility resources should be consulted for verification of existing policies regarding transmission-based and standard precautions. This question prevents the nurse from arguing with the charge nurse, too. Gloves are not required for every client interaction.

The client asks the nurse why the nurse wears a disposable gown every time she enters the client's room. What is the nurse's best response?

"I am required to wear a gown for certain infections that are easily passed to others." - The client needs a matter-of-fact response that does not make him or her feel dirty, guilty, or confused. The nurse teaches the client in a direct way that some infections are easier to spread, making additional precautions necessary for everyone's protection. It is dismissive to say it is policy or just that there is a sign on the door, and it is unkind to state that the nurse wears a gown to protect everyone else from the client.

The new nurse notes a health care provider enter a client's room without the correct personal protective equipment (PPE). What does the nurse say to the health care provider?

"I notice you did not wear the required PPE." - It is incorrect to confront the provider in a confrontational or accusatory manner. Once the nurse states that this behavior has been observed, the nurse and provider can have a discussion.

Place in correct order the steps for removing a gown. Use all options.

1)Unfasten the ties. 2)Touching only the inside of the gown, pull away from the torso. 3)Keeping hands on the inner surface of the gown, pull gown from arms. 4)Turn gown inside out. 5)Fold or roll the gown into a bundle. 6)Discard the gown.

What is the best source for the nurse to determine the type of transmission precautions a client needs?

Client's medical record - The client's medical record includes the type of precautions to observe and the laboratory reports to verify the organism. The sign on the client's room may be incorrect. Nurses typically ensure the client is on the correct precautions. The assigned nurse updates the charge nurse's report regarding transmission precautions.

The charge nurse notices that when caring for a client, some nurses are wearing personal protective equipment and other nurses are not. Which action would be most appropriate for the nurse to take?

Consult the agency's infection control manual. - If there is a question about transmission-based precautions when caring for a client, the nurse should check the agency's infection control manual and the institution's policies about specific illnesses. Then the nurse should review the mode of transmission associated with the specific microorganism causing the illness. Although asking the health care provider about the client's condition and reviewing the medication record can provide additional information, the infection control manual and policies would be most appropriate to use. Checking with other staff nurses on the unit would be inappropriate because their actions could be inconsistent.

The nurse is required to wear a gown, gloves, goggles, and mask as personal protective equipment (PPE) when caring for an assigned client. What should the nurse put on first?

Gown - When using personal protective equipment (PPE), the nurse would put on the gown first. Then the nurse would then put on the mask and goggles, and lastly the gloves.

The nurse prepares to wear personal protective equipment (PPE) when entering a client's room. What action does the nurse take first?

Perform hand hygiene. - The nurse must perform hand hygiene before putting on gloves, just like any other time. The nurse does not want to introduce additional infectious organisms to this client. The client's door, for most isolation types, can be opened after PPE is on. Though often done incorrectly, when gowning it is important to ensure the gown covers the back and front of the nurse. As the nurse is dressing in PPE it is wise to double check that the correct transmission precautions are being observed and that each piece of equipment needed is being worn by the nurse. The nurse would not be wrong if wearing more than is required but would not want to wear less than is needed.

The nurse notes that a health care provider failed to observe transmission precautions in a client's room and is entering another client's room. What is the nurse's next action?

Remind the health care provider about the transmission precautions. - It is best to directly and immediately address the issue with the health care provider. The nurse may suggest that additional precautions are taken prior to entering the client's room, but really can't insist, and hand hygiene is expected for every client. The charge nurse or supervisor can intervene, following the chain of command, if the health care provider does not take corrective action.

The nurse is wearing a gown as part of using personal protective equipment and is preparing to put on clean disposable gloves. Which placement indicates that the nurse has put on the gloves properly?

The glove ends extend to cover the gown's cuffs. - When properly applied, the edges of the gloves should extend to cover the cuffs of the gown so that there is no visible skin exposed.

The nurse wears personal protective equipment (PPE) when entering the client's room. What is the nurse's goal in wearing PPE?

To prevent infection transmission - The nurse's goal is to prevent infection transmission, including from other clients to this client and from this client to other clients. The nurse does not necessarily have an infection. The nurse is adhering to policy, but that is not the goal of using PPE during client care. The gown protects the nurse's other clients from an infectious organism, but the goal is not prevention of infection in the nurse, though that is a desirable outcome.

Personal protective equipment (PPE) is used in health care facilities for primarily which reason?

To protect both the staff and clients from becoming infected by one another - PPE protects both the staff from clients and the clients from staff. Although the use of PPE provides some protection for the hospital from legal liability, this is not the primary reason it is used.

The nurse prepares to enter a client's room where goggles are required but are not available. Which action by the nurse is best?

Wear a face shield as part of the protective equipment. - The nurse would not delay care due to a lack of goggles. The acceptable alternate is a face shield, which is a mask with a clear plastic covering for the eyes. If goggles are needed, the nurse would not enter the room without eye covering unless there was an emergent reason to do so. However, it is not correct to delay care until goggles can be obtained. This can take quite a long time. Even if the goggles can be supplied soon, the nurse can easily locate and use a face shield.

Which item would the nurse remove first when removing personal protective equipment?

Gloves - When removing personal protective equipment (PPE), the first item to be removed is the gloves. If the gown is tied in the front, the nurse unties the gown first and then removes the gloves. The face shield is removed next, followed by the gown, and lastly the mask.

The charge nurse observes a new nurse not wearing personal protective equipment (PPE) entering and exiting a client's room. The client is on transmission-based precautions. What is the charge nurse's best response?

Reinforce teaching that transmission-based precautions must be observed. - The new nurse may have forgotten, missed the signs, or some other honest error. The charge nurse first offers teaching to the new nurse immediately to prevent further potential harm. An incident report should not be necessary and is not an immediate action. The manager may need to be involved if the issue persists.

The nurse removes personal protective equipment after caring for a client on transmission-based precautions. Which action by the nurse is correct?

Touch the inside of the gown and pull it away from the torso. - The outside of the equipment is considered contaminated. Removal follows a prescriptive sequence. Most personal equipment is removed at the door of the client's room. The contaminated glove grasps the other contaminated glove for removal. The nurse's clean hand reaches under the other glove for removal. Goggles are removed by holding the earpieces. Clean hands touch the inside of the gown for removal, pulling away from the torso. Roll these items up, inside out, for disposal. Grasp ties on mask on respirator for removal after leaving the room.

The nurse is wearing a gown and gloves as part of using personal protective equipment. The gown is tied in the front at the waist and at the neck. Which action would the nurse take first?

Unfasten the gown at the waist. - When removing personal protective equipment, a gown that is tied in the front at the waist is unfastened first because the front of the gown, including the waist ties, are considered contaminated. The nurse would then remove the gloves, one at a time, so that one glove is contained within the other. After discarding the gloves, the nurse would then untie the gown at the neck and back.

The nurse is removing a gown after providing care to a client. Which action would the nurse take first?

Unfasten the ties at the neck and back. - When removing a gown, the nurse first unfastens the ties at the neck and back, and then allows the gown to fall away from the shoulders. Touching only the inside of the gown, the nurse pulls the gown away from the torso. Keeping the hands on the inner surface of the gown, the nurse pulls the gown from the arms, turns it inside out, and folds or rolls it into a bundle to be discarded.