Personal Protective Equipment (PPE) is any item worn to minimize exposure to hazards that can cause serious illness or injury. The process of taking it off, known as doffing, is the most vulnerable point for self-contamination. The outside surfaces of every piece of PPE must be treated as contaminated, and any contact with the skin, eyes, or clothing carries a high risk of spreading infectious agents. A deliberate and standardized procedure is required to ensure that the wearer remains safe during this removal process.
Essential Preparation Before Removal
The process of removing protective gear should never be rushed. Preparation begins before the first item is even touched. A designated “Doffing Zone” should be established to physically separate the contaminated area from the clean area where individuals will exit. This zone needs to be clear of unnecessary items and must contain all the required disposal and hygiene supplies.
Waste receptacles, often color-coded or clearly marked as biohazard bins, must be easily accessible and positioned for immediate, hands-free disposal of contaminated items. Having alcohol-based hand sanitizer or a sink with soap and running water nearby is also a precondition for starting the doffing sequence. Mental preparation is equally important, requiring the wearer to slow down and focus entirely on the precise steps.
The Critical Sequence for Removing Contaminated Items
The first items to be removed are the gloves, which are typically the most contaminated component due to direct contact with the environment. The “glove-in-glove” technique involves grasping the outside of one glove near the cuff with the opposite gloved hand and peeling it off so it turns inside out.
The removed glove should be wadded up and held in the palm of the remaining gloved hand. Next, slide the fingers of the bare hand under the wrist of the second glove and peel it off over the first glove. Immediately following the removal of gloves, the gown or apron should be taken off, as its front and sleeves are considered contaminated.
The ties at the neck and waist must be unfastened, typically by breaking them or untying them without touching the potentially soiled exterior. The wearer then pulls the gown away from the neck and shoulders, touching only the inside surfaces of the fabric. The gown is carefully rolled down and inward, turning it inside out as it is peeled away from the body to contain the external contamination in a bundle. This bundle is immediately placed into the designated waste receptacle without agitating the material.
Eye protection, such as goggles or a face shield, is removed next by handling only the clean parts, such as the headband or ear pieces. The front surface must be avoided entirely, and the eyewear should be lifted away from the face and placed into a designated container for disposal or reprocessing.
Post-Removal Hygiene and Disposal
The final piece of protective gear to be removed is the mask or respirator, which is done last because it protects the wearer’s nose and mouth from airborne contaminants during the entire process. The front of the mask is considered contaminated, so the wearer must avoid touching it completely. Removal is achieved by grasping the bottom ties or elastics and then the top ones, pulling the mask away from the face and disposing of it.
Immediate and thorough hand hygiene is required. After all equipment has been removed, the hands must be washed with soap and water for at least 20 seconds, ensuring all surfaces, including the back of the hands, between the fingers, and under the nails, are scrubbed. If soap and water are not available, an alcohol-based hand sanitizer with at least 60% alcohol should be used as a temporary measure.