Personal protective equipment (PPE) refers to specialized garments and devices designed to protect the wearer from infection or injury by creating a physical barrier against hazardous materials and pathogens. This ensemble typically includes items meant to protect the skin, respiratory tract, and mucous membranes. Following the correct step-by-step sequence for donning PPE is a foundational safety measure that ensures the integrity of the protective barrier and prevents contamination during the process.
Understanding the Standard PPE Components
A standard PPE ensemble, particularly in healthcare settings, involves four primary components that cover the body, face, and hands. The isolation gown is the first layer, creating a large-scale physical barrier against splashes and droplets to protect the wearer’s clothing and exposed body areas.
Respiratory and facial protection includes a mask or respirator and separate eye protection, such as goggles or a face shield. The mask filters the air and prevents inhalation of airborne particles, while eye protection shields the mucous membranes from direct contact with splashes. The final component is a pair of gloves, which protect the hands from contact contamination.
Step-by-Step Guide to Donning PPE
The process of putting on PPE begins with proper hand hygiene, using either soap and water or an alcohol-based hand rub.
The sequence starts with the gown, which must be secured meticulously to cover the entire torso. The gown should fully cover the body from the neck down to the knees, extending to the end of the wrists. It is fastened at the back of the neck and the waist to ensure the back is covered and there are no gaps in the barrier.
Next, the wearer puts on the mask or respirator, positioning it over the nose, mouth, and chin. For a surgical mask, the ties or ear loops are secured, and the flexible nose piece is molded tightly to the bridge of the nose for a snug fit. If a specialized respirator, such as an N95, is used, a user seal check must be performed to confirm no air leaks around the edges.
Eye protection is donned after the mask, placed correctly over the face and eyes, with the straps adjusted for a secure fit. If a face shield is used, it should extend below the chin and wrap around the sides of the face for maximum coverage. The eye protection must not interfere with the seal of the respirator or the position of the mask.
The final step is putting on the gloves. The gloves must be pulled over the cuffs of the gown to create a continuous, seamless barrier from the hand to the mid-forearm. This placement ensures the skin of the wrist is not exposed and the gown cuff is fully covered and sealed.
The Rationale Behind the Donning Order
The precise order for donning PPE is designed to achieve two primary safety goals: minimizing the risk of self-contamination and establishing a complete, integrated barrier. The gown is put on first because it provides the largest surface area of protection for the body. This shields the main body while the wearer prepares the respiratory and hand barriers.
Placing the mask and eye protection next ensures that the respiratory tract and mucous membranes are protected before the hands are covered. Gloves are reserved for the last step because the hand is the most likely point of contact with contaminants.
By pulling the gloves over the gown cuffs, the sequence ensures that the glove seals the most exposed part of the gown (the wrist). This layered approach ensures the outer surfaces of the gloves and the gown function as a single unit, eliminating gaps and creating an uninterrupted physical barrier.
The Critical Step of Safe PPE Removal
While donning establishes the barrier, the removal process, known as doffing, is the highest-risk time for self-contamination. The sequence is based on the “dirty-to-clean” principle, where the most contaminated items are removed first.
Gloves are removed first because they are the most contaminated surface and must be carefully peeled off inside-out without touching the exterior. The gown and gloves are often removed together to bundle the contaminated surfaces away from the wearer. Hand hygiene is performed immediately after the initial removal of the gown and gloves before touching the face-protecting equipment.
Eye protection is removed next, handling it only by the head strap or ear pieces to avoid touching the contaminated front surface. The mask or respirator is removed last, touching only the ties or elastic bands, and is discarded after leaving the exposure area. Thorough hand hygiene is mandatory immediately after all PPE has been removed.