Personal Protective Equipment (PPE) refers to specialized clothing and equipment designed to protect the wearer from injury or the spread of infection or illness. Its primary function is to create a physical barrier between the wearer’s skin, mouth, nose, and eyes and potentially infectious materials like viruses or bacteria. PPE includes items such as gloves, gowns, masks, respirators, and eye protection, selected based on the specific type of exposure anticipated. Adhering to a precise sequence for both putting on and taking off this equipment is rooted in infection control science. A single mistake can compromise the entire barrier, increasing the risk of self-contamination and the spread of infectious agents.
Preparation Before Putting On Equipment
Before any protective equipment is worn, several preparatory steps must be completed to ensure the barrier’s effectiveness. The process begins with performing thorough hand hygiene, either by washing with soap and water for at least 20 seconds or using an alcohol-based hand rub. This initial step cleans the hands before they touch the clean inner surfaces of the PPE items.
The user must then gather all necessary equipment and perform a careful inspection of each item. Confirm that gowns are the correct size, gloves are free of tears or punctures, and that all components are within their expiration dates. For respiratory protection, such as an N95 respirator, the user must have received prior fit testing to confirm the device seals properly to the face. If a respirator is worn, the user must be prepared to perform a user seal check once it is in place to confirm proper pressure seals are achieved.
The Correct Sequence for Donning
The process of putting on PPE, known as donning, follows a specific, standardized order designed to place the least contaminated items on first and the most contaminated on last.
1. Isolation Gown
The first item donned is the isolation gown, which provides a barrier over the body’s torso and arms. The gown must be fully secured at the neck and waist to cover all clothing, ensuring the front and sleeves are protected from potential splashes or sprays.
2. Mask or Respirator
Once the gown is in place, the user applies respiratory protection, which is either a surgical mask or a fitted respirator like an N95. If a respirator is used, it must be carefully molded over the nose bridge and secured with straps, followed immediately by the user seal check. The rationale for placing the mask or respirator second is that the straps and ties can be secured under the gown’s collar, preventing contamination of a clean surface.
3. Eye Protection
The third step is to put on eye protection, such as goggles or a face shield, placed over the eyes and face. This barrier protects the mucous membranes of the eyes from droplets and aerosols generated during patient care or procedures. The eye protection is positioned after the gown and mask to ensure the head straps do not interfere with the secure fit of the respirator or the ties of the gown.
4. Gloves
The final item donned is the pair of medical gloves, which are considered the most contaminated item during use. The gloves must be pulled over the cuffs of the gown, creating a continuous, uninterrupted barrier that covers the skin of the wrists. This specific placement ensures that no exposed skin is left between the end of the gown sleeve and the beginning of the glove.
Safe Removal of Contaminated Equipment
The removal of PPE, called doffing, is a sequence that is essentially the reverse of donning and carries the highest risk of self-contamination. The underlying principle for doffing is to move from the most contaminated surfaces to the cleanest, preventing infectious material from contacting the wearer’s skin or clothing. The removal process often begins with the gloves, as they are the most heavily soiled item.
The contaminated gloves are removed using a glove-to-glove and skin-to-skin technique, which ensures the outer, contaminated surface never touches bare skin. Immediately after glove removal, hand hygiene must be performed to decontaminate the hands before touching the next piece of equipment.
Next, the gown is removed by carefully breaking the ties and pulling the gown away from the body. It is turned inside out as it is rolled into a bundle. The inside-out rolling technique is designed to contain the contaminated outer surface, ensuring only the clean inner surface is handled by the wearer.
After the gown and any associated hand hygiene are complete, the eye protection is removed by handling only the ear pieces or the back strap. The front surface of the goggles or face shield is considered contaminated, so the user must avoid touching that area.
The respiratory protection, whether a surgical mask or N95 respirator, is generally the last item to be removed. It is removed by grasping the bottom and then the top straps, pulling the device away from the face without touching the front surface. The respirator is removed last because it protects the user’s airways until they have completely exited the contaminated area. The doffing process concludes with a final, thorough round of hand hygiene.