Personal Protective Equipment (PPE) serves as a physical barrier between an individual and potentially infectious agents, such as viruses or bacteria. The process of safely removing this equipment is known as “doffing,” and it is a procedure just as important as putting the gear on correctly. Doffing involves a precise, sequential method designed to prevent the transfer of contaminants from the gear to the wearer’s skin, clothing, or mucous membranes. Following a strict removal order is the primary mechanism for preventing self-contamination.
Understanding the Contamination Zones
The rationale for a fixed removal sequence centers on the concept of contamination zones, where the outside surface of all PPE is treated as highly soiled. Once a person has been in a contaminated environment, the gloves and gown are considered the “dirtiest” items because they have been in direct contact with surfaces and patients. The goal is to manage the transition from contaminated gear to a clean body without transferring pathogens. This approach ensures that the wearer’s hands, performing the removal, never touch a clean body area after handling a contaminated one. Face and airway protection remain in place until the end to shield the eyes, nose, and mouth from particles stirred up during the removal of larger, soiled garments.
The Standard Doffing Sequence
The standard doffing sequence is structured to remove the most contaminated items first, progressing to the least contaminated items that protect the airway. This deliberate order minimizes the exposure of clean skin or clothing to contaminated surfaces.
The first item to be removed is consistently the gloves, which are the most heavily contaminated element due to frequent contact with the environment. After the gloves are removed and discarded, hand hygiene is immediately performed to prevent bare hands from contaminating the next piece of equipment.
The second item is the protective gown, which is removed while the wearer is still protected by their face and respiratory gear. After the gown is disposed of, another round of hand hygiene is performed, acknowledging the high risk of contact with the contaminated exterior during removal.
Next, eye protection, such as goggles or a face shield, is removed. This step is followed by the mask or respirator, which is only removed once the risk of contamination from other, heavier pieces of gear is entirely eliminated. Hand hygiene must be completed immediately after the final piece of PPE is removed.
Essential Techniques for Safe Removal
The safe execution of the doffing sequence relies on specific techniques designed to contain infectious agents. For glove removal, the “glove-in-glove” method is used: the outside of the first glove is grasped near the wrist and peeled off inside out. This removed glove is then held in the palm of the remaining gloved hand.
The second glove is removed by sliding an ungloved finger under the cuff and peeling it off, also turning it inside out. This effectively creates a sealed bundle containing both contaminated gloves.
When removing the gown, the ties are unfastened. The wearer pulls the garment away from the neck and shoulders, only touching the inside surface. The gown is then turned completely inside out and rolled into a compact bundle, ensuring the contaminated exterior is contained within.
For face protection, whether a face shield or goggles, removal must be done by handling only the straps or ear pieces, never touching the contaminated front surface. Similarly, a mask or respirator is removed by grasping the bottom elastic or tie first, then the top, pulling the device away from the face without contacting the filter area.