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UNIT 3 Essential Nursing Interventions
What if... sections pose questions about special situations and explain alternate ways to perform procedures to aid students in knowing what to do.
Procedure 19-3 ■ Removing Personal Protective Equipment (PPE) ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover. For this procedure, also refer to Clinical Insights 19-2 and 19-3 if you need more information.
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CHAPTER 19 Promoting Asepsis & Preventing Infection
KEY POINT: Considered contaminated: front areas, sleeves, mask, and gloves of the PPE, and head and shoe covers, if you are wearing them.
KEY POINT: Considered clean: inside of the gown, gloves, ties on the mask and at the back of the gown, and the inside of the head and shoe covers, if you are wearing them.
5. Remove your mask or face shield unless the mask is a respirator. In that case, remove it after leaving the patient room and closing the door. a. Untie the lower ties first. b. Untie the upper ties next, being careful not to let go of the ties. c. Touch only the ties; do not touch the front of the mask. d. Dispose of the mask by holding on to the ties and placing it in a desig- nated waste container. Ties are considered clean. Touching the outside of the mask would con- taminate your hands. 6. Remove your hair covering. a. Slip your bare fingers under the edge of the hair cover, being care- ful not to touch the outside of it. b. Lift it up and away from your hair. c. Touching only the inside of it, place it in a designated waste container. The inside of the hair covering is con- sidered clean, so you may touch it with your bare hands. 7. Remove shoe covers. Be careful to touch only the insides of the covers. 8. Perform hand hygiene immediately after removing PPE.
Folding the gown prevents contamina- tion of your hands, the clothing, and the environment.
Even if wearing gloves, hands may become contaminated. 9. Close the door. Keeping the door closed contains con- taminants and makes signage more visible. What if . . . ■ The gown is tied in front? Untie the front gown ties before removing your gloves; then remove the gloves and untie any back ties (e.g., at the neck). (This would be an unusual circumstance.) Because the front of the gown (including a front tie) is considered contaminated, once you remove your gloves, you could not use your bare hands to untie a front tie. ■ I am wearing two gowns (top one tied in back, inner one tied in front)? Remove gloves; untie waist ties of outer gown, remove the gown, and fold it inside out. Remove the inner gown by untying it in front. Fold inner gown inside out. Take off goggles and face mask or shield. !
➤ When performing the procedure, always identify your patient according to agency policy, using two identifiers, and be attentive to standard precautions, hand hygiene, patient safety and privacy, body mechanics, and documentation.
Procedure Steps 1. Remove gloves first (unless the gown ties in front; in that case, see “What if . . .”). Gloves are the most contaminated PPE and must be removed first to avoid con- tamination of clean areas of the PPE during their removal. a. Remove the first glove: 1) Grasp the outside cuff of the glove with the opposite gloved hand. 2) Pull downward so that the glove turns inside out. 3) Do not touch the skin of your wrist or hand with your gloved hand.
3) Pull the glove off, inside out, over the glove that hand is holding. Do not touch the out- side of the soiled glove with your bare fingers. The insides of gloves are consid- ered clean because they have not been in contact with the client or contaminated surfaces. Therefore, you can touch the insides with your bare hands.
b. Slip your hands inside the neck and peel the gown away from the shoulders. 1) Reach inside to pull off the cuff; remove your arm from the sleeve. 2) Repeat the maneuver to remove the second sleeve. 3) Do not touch the front of the gown, even if it is not visibly soiled. The inside of the gown is clean and will not contaminate your hands. The front of the gown and the sleeves are considered contaminated.
4. Remove goggles. a. Grasp only the earpieces (or headband) of the goggles and pull off the face. b. If the goggles are not disposable, place in the container provided for disinfection. Earpieces are considered clean. Some goggles are cleaned and reused.
The outside of both gloves is con- taminated. To prevent contam- ination, touch only the outside (contaminated) surface of first glove to outside (contaminated) sur- face of second glove.“Dirty touches dirty” and “clean touches clean.”
Patient Teaching See Procedure 19-2.
Practice Resources AORN (2024); CDC (n.d.b; 2022, October 3, reviewed); Cowperthwaite & Holm (2015); Ortega et al. (2015); Siegel et al. (2023, May, updated);Tomas et al., 2015;WHO (2015, January 28).
c. Dispose of gloves in a designated waste container, keeping them away from your body. 2. Remove the gown: a. Release the waist ties and the neck ties of the gown, bending slightly forward to allow the gown to fall forward. Allowing the gown to fall forward exposes the clean area for the hands to grasp more readily.
Home Care See Procedure 19-2.
Thinking About the Procedure
Documentation The removal of PPE is generally assumed and does not require documentation.
To practice applying clinical reasoning to this procedure, the video Removing Personal Protective Equipment (PPE), along with questions and suggested responses, is available on the Davis’s Nursing Skills Videos Web site on DavisPlus.
3. Fold the gown so the inside of the gown is to the outside. Holding the gown away from your uniform, roll it up with the contaminated front and sleeves in the center, and place in the designated waste container.
b. Remove the second glove: 1) Hold the removed glove in the palm of your gloved hand. 2) Slip two ungloved fingers inside the cuff of the remaining glove.
Procedure 19-4 ■ Surgical Hand Washing:Traditional Method ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover. For this procedure, also refer to Clinical Insights 19-2, 19-3, and 19-4 if you need more information.
Equipment ■ Antimicrobial soap (FDA-approved for surgical hand asepsis)
■ Deep sink with foot or knee controls or motion-sensor faucet ■ Surgical shoe covers, cap, and face mask ■ Sterile gloves of the correct size ■ Surgical pack containing a sterile towel (continued on next page)
Over 230 step-by-step procedures with rationales teach students how to perform and master essential nursing skills.
■ Soft, nonabrasive scrub sponge ■ Disposable single-use nail cleaner
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