Isolation Precautions and PPE: What the NCLEX Tests
What it is
Standard precautions apply to every client; transmission-based precautions are added when an organism spreads by air, droplets or contact. The route decides the room and the PPE. Airborne nuclei (5 microns or smaller) stay suspended and drift on air currents, so they need a negative-pressure airborne infection isolation room (AIIR) and a fit-tested N95 respirator. Larger droplets fall within about 3 to 6 feet and need a surgical mask; contact organisms live on skin and surfaces and need a gown and gloves.
What the NCLEX focuses on
- Airborne: pulmonary or laryngeal tuberculosis, measles (rubeola), varicella and disseminated herpes zoster (airborne plus contact); keep the AIIR door closed.
- Droplet: influenza, pertussis, mumps, rubella, Neisseria meningitidis meningitis and Mycoplasma pneumonia; private room or cohort, surgical mask on room entry.
- Contact: MRSA, VRE, Clostridioides difficile, scabies, RSV and draining wounds; dedicate the stethoscope and blood pressure cuff to the room.
- C. difficile: wash hands with soap and water, because alcohol does not kill spores; clean surfaces with a sporicidal (bleach) product.
- Donning order: gown, mask or respirator, goggles or face shield, gloves. Removal order: gloves, goggles or face shield, gown, mask or respirator, then hand hygiene.
- Remove the N95 after leaving the room and closing the door.
- For transport, the client with airborne or droplet precautions wears a surgical mask, never an N95.
Priority nursing actions
- Start precautions on suspicion, before the diagnosis is confirmed (cough, night sweats, weight loss: AIIR now).
- Perform hand hygiene and don PPE in order before entering the room.
- Keep the AIIR door closed and confirm negative pressure; cohort only clients with the same organism.
- Limit transport; mask the client and notify the receiving department.
- Remove PPE in order and perform hand hygiene immediately after the last item.
Numbers to know
| Item | Standard | Why it matters |
|---|---|---|
| Airborne particle size | 5 microns or smaller | Stays suspended; requires AIIR and N95 |
| Droplet range | About 3 to 6 feet (1 to 2 m) | Mask is worn on entering the room |
| AIIR air exchanges | At least 6 per hour (existing room); 12 per hour (new construction) | Dilutes and removes infectious nuclei |
| N95 fit testing | Before first use and every year | A leaking seal gives no protection |
| Alcohol hand rub | 20 to 30 seconds until dry | Not effective against C. difficile spores |
| Soap and water wash | 40 to 60 seconds | Required for visible soil and C. difficile |
Common exam traps
- Choosing a surgical mask for the nurse entering a tuberculosis room: wrong because only a fit-tested N95 filters airborne nuclei.
- Choosing an N95 for the client during transport: wrong because the client wears a surgical mask to contain secretions.
- Choosing droplet precautions for varicella or disseminated zoster: wrong because both need airborne plus contact precautions.
- Choosing alcohol hand rub after C. difficile care: wrong because spores survive alcohol.
- Choosing to room a client with MRSA with a client who has VRE or with a neutropenic client: wrong because cohorting is allowed only for the same organism.
What to teach
- Visitors perform hand hygiene on entering and leaving and wear the PPE staff show them; ill visitors stay away.
- Cover coughs and sneezes with a tissue, discard it, then clean the hands.
- At home after C. difficile, wash hands with soap and water and clean the bathroom with a bleach-based product.
Try 2 NCLEX-style questions on this topic
From the NCLEXPace question bank. Pick your answers, then check them inside NCLEXPace.
For each infection in an acute-care setting, select the transmission-based precaution category. Assume tuberculosis is infectious pulmonary disease. If both respiratory and contact precautions apply, select the respiratory category.
For each row, select the correct column.
| Airborne | Droplet | Contact | |
|---|---|---|---|
| Tuberculosis | |||
| Influenza | |||
| Methicillin-resistant Staphylococcus aureus (MRSA) skin infection | |||
| Varicella (chickenpox) | |||
| Pertussis (whooping cough) |
A nurse has finished suctioning a client in an airborne infection isolation room and begins removing personal protective equipment. When should the N95 respirator be removed?
Select the best answer.
- A. Remove the N95 at the bedside before taking off the gloves and gown so the respirator does not interfere with removing the other PPE
- B. Step into the hallway and remove the N95 first, then remove the gloves and perform hand hygiene after all PPE has been discarded
- C. Remove the gown and eye protection first, then remove the N95 just inside the doorway before stepping into the hallway
- D. After leaving the room and closing the door
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- Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Centers for Disease Control and Prevention; 2007.
- Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. MMWR Recomm Rep. 2002;51(RR-16):1-45.
- Harding MM, Kwong J, Hagler D, Reinisch C. Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical Problems. 12th ed. Elsevier; 2023; Chapter: Infection.
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