Nursing Field Notes / Nursing Core · Fundamentals of Nursing Course

PPE & Infection Control 🛡️

Standard Precautions · Transmission-Based Precautions · Donning & Doffing

NG-073 Nursing Core ADHD-friendly visual edition

Every barrier you put on — gloves, gown, mask, goggles — exists to stop germs moving between a contaminated surface and a clean one. Standard precautions apply to every patient, every time; transmission-based precautions stack an extra barrier on top when you know (or suspect) contact, droplet, or airborne spread. The doffing order — not donning — is the single highest-yield NCLEX point in this whole topic.

Clean / protected Contaminated / dirty

📄 Simple Nursing original — opens in Drive →

🧤 Standard = ALWAYSBlood, body fluids, secretions, excretions, mucous membranes, non-intact skin — on every single patient.

🥽 Gloves come off FIRSTDoffing order is reversed and gloves — the dirtiest item — are always removed first.

😷 N95 = AirborneMeasles, TB, Varicella (chickenpox/shingles) need an N95 & negative-pressure room.

🧼 Hand hygiene = LASTThe final step of doffing, every single time, no exceptions.

🧤

STANDARD PRECAUTIONS

STEP 1 · THE FLOOR EVERYONE STANDS ON

The baseline layer of protection used on every patient, every encounter — regardless of diagnosis or infection status.

🦠 Why this whole topic exists: nosocomial infection

Sterile & aseptic technique exist to drastically reduce (and ideally eliminate) the chance of bacteria entering a wound, catheter site, or sterile body cavity — cutting the risk of a nosocomial infection, also called a healthcare-associated infection (HAI): "nosocomial" literally means "hospital-acquired."

🧠 "Standard is the floor, transmission is the extra wall." You never drop standard precautions to add contact/droplet/airborne — you always add the new layer on top of gloves + hand hygiene + everything standard already requires.

🧤 Gloves — when

Touching blood, body fluids, secretions, excretions
Touching contaminated items or surfaces
Touching mucous membranes
Touching non-intact skin

🧠 "If it's wet and it's not yours, glove up." Any body substance that isn't sweat = standard-precaution glove indication.

🥼 Gowns — when

Use during procedures & patient-care activities when contact of your clothing or exposed skin with blood, body fluids, secretions, or excretions is anticipated — think splash, spray, or heavy contact, not just a quick vitals check.

🧠 Gown = protects your clothes; gloves = protect your hands. Different barrier, different job.

😷 Surgical mask — when

Wear a surgical mask within 3 feet (<3 ft) of a patient when respiratory secretions or splash to the face are anticipated — this is a standard-precaution mask, distinct from the N95 respirator reserved for airborne precautions (Step 2).

🧠 "3 feet, surgical. Airborne, N95." Distance-based splash protection is a different tool from a fit-tested airborne respirator — don't mix them up on the exam.

🚧

TRANSMISSION-BASED PRECAUTIONS

STEP 2 · ADD THE RIGHT WALL

Three categories, three barriers, three sets of diseases — contact, droplet, and airborne each protect against a different way germs travel.

🚧 Contact vs. Droplet vs. Airborne — side by side

Type	Extra barrier	How it spreads	Example diseases
🤲 Contact	Gown + gloves for touching patient/environment	Direct or indirect touch — skin, equipment, surfaces	MRSA, VRE, C. diff, wounds, scabies
💧 Droplet	Surgical mask, <3 ft or entering room	Large respiratory droplets — cough, sneeze, talking	Flu, strep, pertussis, mumps, rubella
🌬️ Airborne	N95 respirator + negative-pressure room	Tiny particles that float & travel on air currents	Measles, TB, Varicella (chickenpox/shingles)

🧠 Barrier scales with particle size. Big & heavy droplets fall within 3 feet → mask. Tiny airborne particles float across a whole room → N95 + negative pressure. Contact isn't about the air at all — it's about what your hands and gown touch.

💧 Droplet precautions — mnemonic "SPIDERMAN"

Scarlet fever, Strep pharyngitis
Pertussis (whooping cough), Parvovirus B19 (5th disease)
Influenza (also contact)
Diphtheria (pharyngeal)
Epiglottitis (H. influenzae type b)
Rubella (German measles)
Mumps, Meningitis (meningococcal), Mycoplasma pneumonia
AdeNovirus (also contact)

🧠 "SPIDERMAN swings 3 feet, then stops." Droplets are heavy — they can't hang in the air like Spider-Man's web across a whole room. Mask up within 3 feet, no negative pressure room needed.

🌬️ Airborne precautions — mnemonic "MTV"

Measles
Tuberculosis (TB)
Varicella — chickenpox and disseminated herpes zoster/shingles (airborne + contact)

🧠 MTV plays on air. All three float on air currents across a whole room — door stays closed, negative-pressure room, fit-tested N95.

🤲 Contact precautions — mnemonic "MRS WEE"

Multidrug-resistant organisms — MRSA, VRE
Respiratory infections — RSV, parainfluenza
Skin infections — impetigo, lice, scabies, herpes simplex
Wounds with excessive drainage / staph
Enteric — C. diff, norovirus, rotavirus (soap & water only — sanitizer does NOT kill C. diff spores)
Eye infections — conjunctivitis

🧠 "MRS WEE has an accident" — she picked up a resistant bug, has a runny nose, a rash, a weepy wound, and can't make it to the bathroom. Everything on this list is something your hands or gown can carry to the next patient.

🧻 Special case: C. diff needs soap & water, not sanitizer

EXAM TRAP Alcohol-based hand sanitizer does not kill Clostridioides difficile spores. For diarrheal illnesses of unknown origin or confirmed C. diff, norovirus, or rotavirus — wash with soap and water every time. Also remember Hepatitis A is spread through stool, so diapered or incontinent patients need the same enteric-contact awareness.

🧠 "Spores laugh at sanitizer." Friction + running water physically washes spores away; alcohol gel just isn't strong enough to destroy them.

🥽

DONNING & DOFFING

STEP 3 · THE ORDER THAT'S TESTED

Putting PPE ON is forgiving. Taking it OFF is not — the doffing order is the single highest-yield fact in this topic.

🥼 Donning (putting ON) — outside-in

🥼 Gown — tie in back

😷 Mask or respirator — mold to nose, check seal

🥽 Goggles or face shield

🧤 Gloves — pull cuffs over gown sleeves

🧠 "Gown-Mask-Goggles-Gloves = GMGG, biggest to hands." You build the barrier from your core outward — gloves go on last so the cuff seals over the gown sleeve.

🥽 Doffing (taking OFF) — most contaminated FIRST, hand hygiene LAST

🧤 Gloves first — they touched the patient directly and are the most contaminated item on your body
🥽 Goggles / face shield next — grab by the strap/ear pieces only, never the front
🥼 Gown next — unfasten at the neck, pull down and away rolling it inside-out, contaminated side stays inward
😷 Mask / respirator last of the PPE — touch only the ties/loops, never the front panel
🧼 Hand hygiene — the true final step of every doffing sequence

📍 Order is one question, where is another. Everything comes off at the doorway or in the anteroom — inside the room — except an N95, which stays on until you have left the room and closed the door. That is the whole point of a respirator: the air you are protecting yourself from is still in there. Hand hygiene then happens after it comes off.

🧠 "Doffing runs backward from donning — remove the dirtiest thing first." Donning went Gown→Mask→Goggles→Gloves (core to hands). Doffing reverses it AND leads with the item touching the most contamination: Gloves→Goggles→Gown→Mask, hands washed last.

🚨 NCLEX trap: why gloves come off first

Gloves are the single most contaminated surface on your body after patient contact — leaving them on while you touch your goggles, gown ties, or mask would transfer pathogens straight to those "cleaner" surfaces. Removing them first protects everything you touch next.

🧠 If an NCLEX question asks "what do you remove first?" and gloves are an option — gloves win, every time.

✅ Do — safe doffing habits

Peel gloves off touching only the outside-to-outside, then tuck the second glove inside the first
Discard PPE in the designated receptacle before leaving the room
Perform hand hygiene immediately after the last item comes off

🧠 "Glove in a glove." The classic peel-and-tuck keeps the contaminated outer surface balled up inside, away from your bare skin.

⚡

QUICK RECALL

SAY IT OUT LOUD

🧤 Standard precautions= every patient, every time — gloves, gown, mask as indicated

🚧 Contact / Droplet / Airborne= gown+gloves / mask <3ft / N95 + negative pressure

🧠 SPIDERMAN · MTV · MRS WEE= droplet · airborne · contact disease mnemonics

🥽 Doffing: gloves first, wash last= the #1 tested fact in this topic

🎯 Cover & check — 4 rapid-fire questions

Q1: What is the very first item removed when doffing PPE?

Gloves — they're the most contaminated item and removing them first prevents transferring pathogens to your goggles, gown, or mask.

Q2: A patient has active TB. What PPE and room setup are required?

Airborne precautions — a fit-tested N95 respirator and a negative-pressure isolation room with the door closed (MTV: Measles, TB, Varicella).

Q3: A patient has C. diff diarrhea. Is alcohol-based hand sanitizer enough?

No — sanitizer does not kill C. diff spores. Use soap and water with friction, and apply contact precautions (gown + gloves).

Q4: What is the last step of every doffing sequence, without exception?

Hand hygiene — performed immediately after the final PPE item (mask/respirator) is removed.

📌

STUDY SHEETS

FROM YOUR SAVED SET

The white cell count — normal 5 to 10 k/mm³, high means infection or inflammation, and low means the patient is at risk of infection. — swipe it sideways if it is cut off, or tap to open it full size.

Saved study graphics from your own collection. Each one is someone else’s work — check anything clinical against your course materials before you rely on it.