Personal protective equipment is a shield that protects both healthcare workers and patients and should be applied and removed in the correct sequence to avoid cross-contamination. Donning involves putting on the required apparel before patient contact and must be performed in the following order; hand hygiene, gown, mask, eye or face protection, and gloves. When doffing, hand hygiene must be performed after taking off each item; starting with gloves, eye or face protection, gown and mask. If the proper procedure is not followed, blood, body substances, and other potentially infectious material could be transferred to both healthcare workers and patients.
PPE Donning Sequence
1. Gown
- Fully cover torso from neck to knees, arms to end of wrists, and wrap medical gown around the back
- Fasten in back of neck and waist
2. Mask or Respirator
- Secure ties or elastic bands of face mask/respirator at middle of head and neck
- Fit flexible band to nose bridge
- Fit snug to face and below chin
- Fit-check respirator
3. Goggles or Face Shield
- Place over face and eyes and adjust to fit
4. Gloves
- While holding the top edge of the cuff, carefully insert hand into the first glove and don
- Use the folded fingers of the gloved hand to gently ease your other hand into the glove
- Extend both gloves to cover wrists of gown
PPE Doffing Sequence
1. Gloves
- Grasp outside of glove with opposite gloved hand and peel off
- Hold removed glove in gloved hand and slide fingers of hand under remaining glove at wrist
- Peel glove off over first glove and discard gloves in waste container
2. Goggles or Face Shield
- To remove, handle by headband or ear pieces for goggles and/or face shield
- Place in designated receptacle for reprocessing or in waste container
3. Gown
- Unfasten ties and pull away from neck and shoulders touching inside of gown only
- Turn medical gown inside out
- Fold or roll into a bundle and discard in waste container
4. Mask or Respirator
- Front of face mask/respirator is contaminated and should not be touched
- Grasp bottom and top ties or elastics of face mask for removal
- Discard in waste container
Download Brochure for Donning and Doffing PPE
Download Brochure for Donning and Doffing Examination Gloves
Over the course of the past five months, the subject of personal protective equipment [PPE] has entered the collective mindset like never before. Shortages of crucial equipment have left frontline healthcare workers vulnerable during a period of pandemic, while everyday citizens adjust to the new norm of putting on PPE before stepping outside the house.
Healthcare professionals [HCP] must take the necessary precautions and follow carefully designed protocol to ensure their own health and safety, as well as that of the patients in their care.
Since HCP are mandated to assume the presence of an infectious agent in the patient’s blood or body fluids, this protocol includes proper hand hygiene and the appropriate donning, doffing and handling of all PPE.
These best practices aren’t just for hospital workers, as everyone from the general public to doctors and dentists treating non-coronavirus patients are now relying on PPE to stay safe. Whether you’re wearing a full set of PPE, or just gloves and a face mask, the order and methods in which you put them on and take them off are equally crucial to the protective equipment’s effectiveness.
Best Practice Basics for Donning PPE
Beyond outlining the appropriate order for putting on and taking off PPE, the CDC also provides general recommendations to be followed by all HCP interacting with patients, regardless of the healthcare setting.
Here are some of the CDC’s key recommendations for the appropriate use of PPE:
- Don PPE prior to patient contact and before entering the patient’s room.
- Once it is on, use PPE carefully to avoid contamination.
- Work from clean to dirty.
- Keep your hands away from your face.
- Limit your contact with surfaces.
- Discard and replace your PPE when it’s torn or heavily contaminated.
How to Safely Put on PPE
The daily responsibilities of HCP during ordinary times are demanding, both mentally and physically. In the midst of the current and unprecedented public health crisis, it’s natural for even the most resilient healthcare workers to become overextended by the sheer caseload of patients that require immediate attention for potentially life-threatening, communicable respiratory illness.
It’s easy to understand how a medical professional may be inclined to hurry through the process of putting on or taking off their PPE in an effort to move on to the next patient. But following proper protocol is especially important right now to prevent the spread of infection for both patients and healthcare personnel.
Here are the CDC’s recommendations for safely donning PPE:
- Perform hand hygiene.
- Put on your gown – Fully cover your torso from neck to knees and your arms to the end of your wrists. Fasten the gown behind the back of your neck and waist.
- Put on your respirator – Cup the respirator with the nosepiece at your fingertips and the headbands hanging below your hands. Lift the respirator to your chin with the nosepiece pointing upward. Use your other hand to pull the top strap over, fastening it behind your head and over your ears. Position the bottom strap behind your neck and below your ears, being careful not to criss cross the straps.
From there, fit the flexible band to the bridge of your nose, adjust to fit snugly to your face and below your chin, and finally, fit-check your respirator.
- Put on your face shield or goggles – Position over your face and eyes, and adjust to a secure fit.
- Put on your gloves – Extend the gloves to cover the wrist portion of your gown.
Best Practice Basics for Removing PPE
The CDC also outlines general best practices for safely removing PPE, which include:
- When patient care is completed, remove all PPE except for your respirator before exiting the patient’s room. Discard it in an appropriate receptacle.
- Perform immediate hand hygiene.
- Consider the front and sleeves of your gown, the front of your mask and face shield, and the outside of your gloves to be contaminated regardless of the visible appearance of contaminants.
Where to remove your PPE will depend upon how much and what type of PPE you wear, and also the reason for the patient’s isolation.
For example, if you only wear gloves, you can remove and discard them in the patient’s room. When you’re wearing full PPE [gown, gloves, mask, goggles/face shield], remove it either at the doorway to the patient’s room or in a dedicated anteroom.
In any event, you should always remove respirators after safely exiting the patient area.
How to Safely Remove PPE
The CDC outlines two examples of how to safely remove personal protective equipment in hospital environments: removing the gloves independently, and removing your gown and gloves together.
If you remove your gloves independently as a first step without the gown, it may be more likely that your hands come into contact with contaminated surfaces.
It’s best to assume that the outside of your gloves, gown, mask and face shield are contaminated. If your hands get contaminated at any point when you’re removing your PPE, immediately wash them or use an alcohol-based hand sanitizer.
- *Remove your gown and gloves together – With gloves still on, grasp the front of the gown at your chest with both hands and pull away from your body to break the ties around the back of your neck. As you remove the gown, fold or roll it inside out. When you reach the areas of your wrists, peel off your gloves, being cautious to only touch the inside of your gloves and gown with bare hands. Discard in the proper receptacle.
- Perform hand hygiene
- Remove your goggles / face shield – Remove your goggles or face shield from the back by lifting the headband without touching the front of the goggles or face shield. If reusable, place in a designated receptacle for reprocessing. Otherwise, discard in the proper receptacle.
- Remove mask / respirator – Grasp the bottom ties or elastic bands of your mask or respirator, then the top ties or bands, and lift it over your head without touching the front of the mask.
- Perform hand hygiene
* If you remove your gloves independently as a first step, use a gloved hand to grasp the palm area of the other glove and peel it off without contacting your skin. Then, hold the removed glove in your gloved hand; slide the fingers of your ungloved hand under your remaining glove at the wrist; peel off your second glove over the first glove.
Complying with basic best practices for donning and doffing PPE can help prevent the spread of infection, whether you’re in a hospital setting or simply performing a teeth cleaning.
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