Doffing PPE means removing it in a specific order so that contaminated outer surfaces never touch your skin, clothes, or face. The standard sequence is gloves first, then gown, then eye protection, then mask or respirator, with hand hygiene between every step. Getting this wrong is common: a randomized study of 76 healthcare workers found self-contamination occurred in about 28% of doffings, most often on the arms, abdomen, and lower limbs.
Why the Order Matters
Every piece of PPE has a contaminated zone and a clean zone. Gloves are the most contaminated item because they touch patients and surfaces directly. The front of your gown, the outer surface of your mask, and the front of your goggles are all considered contaminated. The ties, straps, and bands that sit against your head or neck are relatively clean. The entire doffing sequence is designed so you only ever touch clean zones with bare hands.
Contamination on the upper portions of PPE (gown chest, mask front) is roughly 2.4 times more likely to cause self-contamination during removal than contamination on the lower portions. That’s why the face mask comes off last, after everything else is safely discarded and your hands are freshly cleaned.
Step 1: Remove Gloves
The standard technique is sometimes called “glove to glove, skin to skin.” With one gloved hand, pinch the outside of the opposite glove near the wrist and peel it off, turning it inside out as it comes away. Hold the removed glove in a ball in your still-gloved hand. Then slide two fingers of your bare hand under the wrist of the remaining glove, touching only the inside surface, and peel it off over the first glove. You end up with one glove tucked inside the other, contaminated surfaces sealed inward. Discard both into the waste container.
Perform hand hygiene immediately.
Step 2: Remove the Gown
The front and sleeves of the gown are contaminated. Reach behind your neck and unfasten the neck ties first, then the waist ties. Once the ties are loose, pull the gown forward off each shoulder using a peeling motion, working it toward the same hand so the gown turns inside out as it comes off. This keeps the contaminated outer surface folded inward. Hold the bundled gown away from your body, roll it into a ball, and place it in the waste or linen receptacle.
Perform hand hygiene again.
Step 3: Remove Goggles or Face Shield
The front lens or shield is contaminated, so don’t touch it. Tilt your head slightly forward and grasp the goggles by the headband at the back, or grab a face shield by its ear pieces. Lift up and away from your face. Place the item in a designated receptacle for reprocessing (if reusable) or in the waste container.
Perform hand hygiene again.
Step 4: Remove the Mask or Respirator
The front of the mask is contaminated. Do not touch it at any point. For a surgical mask with ties, grasp the bottom ties first, then the top ties, and lift the mask away from your face. For an N95 respirator with elastic straps, grasp the bottom strap first, pull it over your head, then do the same with the top strap. The reason for bottom-first is that it lets the mask fall forward and away from your face rather than snapping back against it. Discard immediately.
Perform hand hygiene one final time.
Hand Hygiene at Every Step
This is the single most important part of doffing. The California Department of Public Health protocol calls for hand hygiene after removing each individual piece of PPE, not just at the end. That means you clean your hands at least four times during a full doffing sequence: after gloves, after gown, after eye protection, and after mask removal. Use alcohol-based hand rub or wash with soap and water. If your hands are visibly soiled, soap and water is preferred.
Skipping intermediate hand hygiene steps is one of the most common errors. Every time you touch a contaminated surface during removal, your hands pick up pathogens. Cleaning between steps prevents you from transferring those pathogens to the next piece of equipment and then to your face.
Where to Doff
Remove PPE at the doorway of the patient’s room or in a designated doffing area, before you move into a clean space. Waste containers should be positioned at the point of use so you can discard each item immediately without carrying it across the room. If your facility uses a buddy system, your observer should be positioned where they can watch each step and flag mistakes in real time.
Common Mistakes to Avoid
- Touching the front of the mask during removal. This is the most direct route to facial contamination. Handle only ties, straps, or bands.
- Pulling the gown off over your head. The gown should peel forward off the shoulders and roll inside out. Pulling it overhead drags the contaminated front across your face and hair.
- Snapping gloves off quickly. Rushed removal flicks droplets. Peel slowly and deliberately.
- Skipping hand hygiene between steps. Even one missed hand wash can transfer contamination from the gown to your face when you reach for your mask.
- Removing items out of order. Taking off your mask before your gloves, for instance, means contaminated gloves are near your mouth and nose.
Alternate Sequence: Gown and Gloves Together
Some protocols allow you to remove the gown and gloves as a single unit. In this method, you grasp the front of the gown, peel it away from your body, and roll the gloves off along with the sleeves so everything bundles together inside out. This reduces the number of steps but requires more practice to do cleanly. The CDC lists this as an acceptable alternative. Whether you use this method or the step-by-step approach, hand hygiene still follows immediately after.