Donning PPE follows a specific sequence: hand hygiene first, then gown, mask or respirator, eye protection, and gloves last. That order matters because each layer builds on the one before it, creating a continuous barrier with no gaps. Getting it wrong doesn’t just reduce protection in the moment; it also makes safe removal much harder later, which is when most contamination actually happens.
Why the Order Matters
The donning sequence isn’t arbitrary. Gloves go on last because they need to overlap the gown cuffs at your wrists, sealing the transition between layers. The mask goes on before eye protection so goggles or a face shield can sit over it without displacing the seal. Each piece locks the previous one in place.
Research on healthcare workers found that contamination on upper portions of PPE made self-contamination during removal more than 2.3 times as likely. Arms were the most commonly contaminated body part. Donning correctly from the start is what sets you up for a clean removal later, so treat the sequence as non-negotiable rather than a suggestion.
Step 1: Hand Hygiene
Before touching any equipment, clean your hands. If they’re visibly dirty, use soap and water. If not, alcohol-based hand rub works. Either way, cover all surfaces: palms, backs of hands, fingertips, between fingers, and the base of each thumb for at least 15 seconds. With hand rub, keep rubbing until the product is completely dry. This prevents transferring anything onto your PPE before you’ve even started.
Step 2: Gown
Before putting the gown on, inspect it for tears or holes. Even a small compromise in the material defeats its purpose. Slip your arms through and cover your torso fully from neck to knees, with sleeves reaching to the end of each wrist. Wrap the gown around your back so there’s no exposed clothing, then fasten the ties at the neck and waist.
A common mistake is choosing a gown that’s too large. In one observational study of healthcare workers, oversized coveralls dragging on the floor accounted for roughly 11% of all donning errors. A too-large gown is harder to manage and creates contamination risk before you even enter a patient’s room. Pick the size that fits your body snugly without restricting movement.
Step 3: Mask or Respirator
Place the mask or respirator over your nose and mouth. Secure the ties or elastic bands at the middle of your head and neck (not just behind your ears, which loosens the fit over time). Mold the flexible metal band over your nose bridge so there are no gaps at the top, and adjust the lower edge so it fits snugly below your chin.
Seal Check for Respirators
If you’re wearing an N95 or similar respirator, a seal check is required every time you put it on. Skipping this step was the single most common donning error in a study tracking healthcare workers, occurring in about 13% of all observed attempts.
There are two ways to check the seal. For a positive pressure check, cover the exhalation valve with your hands and breathe out gently. You should feel slight pressure build inside the respirator with no air leaking around the edges. For a negative pressure check, cover the filter inlets with your palms, inhale gently until the respirator collapses slightly against your face, and hold your breath for ten seconds. If the respirator stays collapsed with no air seeping in, the seal is good. If you feel leakage with either method, reposition the respirator and try again.
Step 4: Eye Protection
Put on goggles or a face shield and adjust until they fit securely. Goggles should sit flush against your skin around the eyes with no visible gaps. A face shield should cover your forehead and extend below your chin, and it needs to be compatible with the respirator underneath.
Face shields are effective at blocking larger respiratory droplets, but smaller airborne particles can flow around the edges. That’s why face shields are typically worn in addition to a respirator, not instead of one, especially during procedures that generate aerosols. The eye protection goes on after the mask so it sits over the top edge of the respirator without breaking its seal.
Step 5: Gloves
Gloves are always the last piece of PPE you put on. Select a pair that fits your hand size well. Too loose and you lose dexterity and grip; too tight and they tear more easily. For standard isolation precautions, non-sterile gloves are appropriate.
The critical detail: pull the glove cuffs up and over the wrists of your gown sleeves. This overlap creates a continuous barrier from your torso down to your fingertips. If there’s a gap between the glove and the gown cuff, that’s exposed skin where fluids or contaminants can reach you. After pulling the cuffs over, check the seal visually. About 4% of donning errors in observational research involved failing to inspect the glove seal, which can leave small tears or gaps unnoticed.
Setting Up Your Donning Area
Where you put on PPE matters nearly as much as how you do it. A well-organized donning area keeps the process smooth and reduces the chance of mistakes. Research on designing PPE stations for COVID-19 facilities recommended a minimum area of about 170 square feet (16 square meters) for donning, with all items arranged in the order you’ll use them.
Useful features include a full-length mirror so you can visually inspect your own coverage, clear floor markings separating clean and contaminated zones, and hand sanitizer dispensers mounted at chest height for easy access. If possible, have a trained observer watch you don each piece. Many hospitals use a buddy system or large observation windows for exactly this reason: it’s difficult to spot your own gaps, especially at the back of the gown or the seal of a respirator.
Mistakes That Compromise Protection
Most donning errors fall into a few predictable categories. The most frequent, based on direct observation of healthcare workers, are:
- Skipping the respirator seal check (about 13% of observed attempts). Without it, you have no way of knowing whether the respirator is actually filtering air or just sitting on your face.
- Wearing an oversized gown or coverall (about 11% of errors). Excess fabric drags on the floor, picks up contaminants, and creates tripping hazards.
- Losing balance while stepping into coveralls (about 9% of errors). Standing on one foot to pull on a suit causes swaying, and the suit touches the floor. Use a chair or grab bar for stability.
- Not fully closing zippers or ties (about 4% of errors). An unfastened gown leaves your clothing or skin exposed and creates a gap that contaminants can enter during removal.
- Not inspecting glove integrity (about 4% of errors). A pinhole tear in a glove is invisible at a glance but eliminates your hand barrier entirely.
Quick Reference: The Full Sequence
To recap the order from start to finish:
- Hand hygiene for at least 15 seconds
- Gown, inspected for damage, fastened at neck and waist
- Mask or respirator, molded to nose, sealed below chin, with a seal check for respirators
- Eye protection, adjusted to fit over the mask
- Gloves, pulled over gown cuffs to create a continuous barrier
Before entering the patient area or contaminated zone, take a moment to look in a mirror or have your buddy confirm: gown fully closed in the back, respirator sealed with no gaps, eye protection secure, and glove cuffs overlapping the gown at both wrists. Every piece should feel snug but not restrictive, with no exposed skin between layers.