The recommended sequence for removal of personal protective equipment on leaving a patient's room is

Appeared in: GMCH - 2015

Explanation

The correct sequence for removing PPE is designed to minimize self-contamination.
Gloves are considered the most contaminated and are always removed first.
The mask/respirator protects the airway and is removed last, often outside the patient's room, to prevent inhalation of any aerosolized pathogens during the doffing process.
This sequence follows the principle of removing the 'dirtiest' or most contaminated items first.

Option A: The gown is not the last item to be removed. The mask or respirator is removed last to protect the nurse's airway until they have left the contaminated environment.
Option C: The gown should not be removed first while still wearing contaminated gloves. This action would risk transferring pathogens from the gloves to the nurse's uniform or skin.
Option D: The mask should never be removed first. Removing the mask exposes the nurse's mucous membranes (nose and mouth) while other contaminated PPE (like the gown and gloves) are still being worn and handled, increasing the risk of infection.

Clinical Relevance

Nursing practice connection: Use the key finding related to Infection Control and PPE Doffing Sequence to guide bedside assessment, documentation, and the next nursing action.
Correct PPE doffing is a fundamental skill to protect healthcare workers from acquiring healthcare-associated infections (HAIs) from patients.
Failure to follow the correct sequence is a common cause of self-contamination, which can lead to illness in the healthcare worker and further spread of pathogens to other patients and colleagues.
What if? If the patient were on airborne precautions (e.g., Tuberculosis, COVID-19), the N95 respirator would still be removed last, but it must be done after leaving the patient's room and closing the door to prevent exposure to airborne particles remaining in the room.

How to Approach the Question

Identify the core question: It asks for the correct sequence of an action (removing PPE).
Recall the infection control principle for doffing: remove the most contaminated items first and protect your airway until the end.
Identify the most contaminated item: Gloves, which have been in direct contact with the patient or their environment.
Identify the item that protects the airway: The mask/respirator.
Combine these principles: Gloves must be removed first, and the mask must be removed last.
Evaluate the options to find the one that matches this logic: 'Gloves removed first, mask removed last.'

Concept Tested & Keywords

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E6 Microbiology Applied AnjuDhir 3e Part 2 p. 146-148

E6 Nursing Fundamentals Taylor p. 187-189

Practise the full GMCH - 2015

Attempt every question from this paper in a timed mock, then review the full solution for each one.