Personal Protective Equipment (PPE) is a physical barrier designed to shield the wearer from hazards, most commonly infectious pathogens. These items, such as gloves, gowns, and masks, create a protective layer between the body and a contaminated environment. While putting on this gear, known as donning, is important, the process of removing it is arguably more critical for safety. This careful removal process, called doffing, must be performed meticulously to ensure the protective gear does not become a source of infection itself.
Defining Doffing and Its Critical Role
Doffing refers to the systematic and safe removal of Personal Protective Equipment (PPE) after use in a potentially contaminated area. This specific protocol is designed to prevent the transfer of infectious material from the outer surface of the gear to the wearer’s skin, clothing, or the surrounding environment. After exposure, the exterior of all PPE is considered “dirty,” meaning it is potentially covered in pathogens like bacteria or viruses.
The primary danger in doffing is self-contamination, which occurs when the wearer touches the contaminated exterior of the PPE and then touches an unprotected area of their body, particularly mucous membranes like the eyes, nose, or mouth. Pathogens can be transferred instantly during a careless removal, making the final moment of a procedure the highest risk for exposure. The systematic approach of doffing is a proactive measure designed to contain the hazard and isolate it safely, ensuring that one piece of gear is removed in a way that protects the next area to be exposed.
Sequential Steps for Safe Removal
The generally accepted sequence for doffing moves from the most contaminated items to the least, using the gear itself to protect the wearer during removal. Gloves are the first items removed, as they are typically the most heavily contaminated. The “glove-in-glove” technique is used: the wearer grasps the outside of one glove near the wrist and peels it off, balling it up in the palm of the remaining gloved hand. The ungloved fingers then slide under the cuff of the remaining glove, peeling it off inside-out over the first glove, safely containing all contamination.
The gown is typically removed next, as its front and sleeves are also considered contaminated. The wearer unfastens the ties and pulls the gown away from their neck and shoulders, touching only the inside surfaces. It is then carefully rolled inside out, turning the contaminated exterior inward, and folded into a bundle before being discarded. This technique ensures the wearer’s clothing is not exposed to the outside of the gown.
Eye protection, such as goggles or a face shield, is removed by handling only the clean straps or earpieces. The contaminated front surface must not be touched, and the eye protection is lifted away from the face. If the item is reusable, it is placed in a designated receptacle for reprocessing; otherwise, it is discarded.
The final piece of PPE to be removed is the mask or respirator, as it has protected the respiratory tract. The wearer must avoid touching the contaminated front of the mask. Instead, they grasp the bottom ties or elastics first, then the top ones, carefully lifting the mask away from the face and discarding it immediately. The entire doffing process requires slow, deliberate movements, and some protocols may require hand hygiene between the removal of certain items if contamination is suspected.
Post-Removal Procedures
Once the final piece of respiratory protection has been removed, the doffing process transitions into essential post-removal procedures. Immediate disposal of all single-use equipment into a designated infectious waste or biohazard container is required. This action physically separates the contaminated material from the clean environment and the wearer.
The last and most critical step is the immediate performance of thorough hand hygiene, using either soap and water or an alcohol-based hand rub. Even with the most careful technique, microscopic contaminants may have transferred to the hands during the removal of the final items. Hand washing acts as the final barrier, physically removing any remaining pathogens and completing the infection control process.