Personal protective equipment (PPE) acts as a barrier between a person and infectious agents or contaminants. This equipment includes items like gloves, gowns, masks, and eye protection, serving as a fundamental tool in infection control. The sequence for applying (donning) and removing (doffing) this gear is important, as an error can lead to self-contamination and the spread of pathogens. Following a precise, step-by-step protocol ensures the gear functions as intended and maintains a safe environment.
Preparation Before Donning
Before touching any protective gear, complete preparatory steps to ensure a clean start. Initial hand hygiene is the first action, involving washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer (at least 60% alcohol). This removes any pathogens before handling the clean PPE.
Remove all personal items that could interfere with the equipment’s effectiveness or seal. Watches, jewelry, and accessories that might puncture the gown or gloves must be secured away from the work area. A proper fit check for a mask or respirator is impossible if the seal is broken by facial hair, though eye protection can generally be worn over prescription glasses. Finally, ensure all necessary PPE pieces are available and organized in the correct order before starting to put them on.
The Essential Donning Sequence
The donning sequence layers the protective gear from the body outward, ensuring the most contaminated items are handled last.
The process begins with the gown, which should fully cover the torso from neck to knees and the arms to the end of the wrists, secured with ties at the neck and waist. The gown provides a large surface barrier to prevent clothing contamination.
Next, secure the mask or respirator over the nose and mouth, fitting snugly below the chin. For a respirator, perform a fit-check by inhaling and exhaling sharply to ensure a tight seal around the edges. Mold the flexible nose piece firmly to the bridge of the nose to prevent air leakage and fogging of eye protection.
Eye protection, such as goggles or a face shield, is placed over the face and adjusted to fit securely over the mask. The last item donned is the gloves, which cover the most frequently contaminated body part. Gloves must extend to cover the cuffs of the isolation gown, creating a continuous barrier over the wrists. A final check confirms the gown is tied, the mask is sealed, and the wrists are fully covered.
Safe Removal Procedures
The process of doffing (taking off) PPE is the high-risk phase because the outer surfaces are contaminated. The removal sequence minimizes touching contaminated surfaces with bare skin or clean clothing.
Gloves are removed first, as they are typically the most soiled item. Gloves are peeled off inside-out, using a glove-in-glove technique. One gloved hand grasps the outside of the opposite glove near the wrist and peels it off. The removed glove is held in the remaining gloved hand, and the ungloved finger slides under the second glove to peel it off over the first, creating a contaminated bundle.
The gown is removed next by unfastening the ties and pulling it away from the neck and shoulders, only touching the inside surface. Roll the gown inside-out into a bundle and discard it immediately.
Hand hygiene must be performed after the removal of the gloves and gown to clean any potential contamination. Eye protection, handled only by the headband or earpieces, is removed next, avoiding the contaminated front surface. The mask or respirator is removed last, grasping only the ties or elastic bands and pulling it away from the face.
Post-Procedure Steps and Disposal
Once all PPE has been removed, handle used disposable items according to waste management protocols. Contaminated items (gowns, gloves, and masks) should be placed immediately into a designated waste receptacle. In non-healthcare settings, this means a lined trash bin sealed tightly before disposal.
If reusable PPE (such as face shields or goggles) was used, place these items in a specific container for cleaning and disinfection. Reusable gear requires thorough washing and disinfecting before being allowed to air-dry and stored for future use.
The final step is a mandatory session of hand washing or using an alcohol-based hand sanitizer. This final act of hand hygiene ensures that any lingering pathogens transferred during doffing are eliminated.