Personal Protective Equipment (PPE) provides a protective shield against potential hazards, such as infectious pathogens or hazardous materials. While putting on this gear (donning) creates the barrier, the greatest risk of contamination occurs during its removal (doffing). This process requires a strict, mandated sequence because improperly removing contaminated materials can easily lead to transferring microbes to the wearer’s skin, clothing, or mucous membranes. Following this protocol ensures the protective barrier is dismantled without causing self-contamination.
Why the Order of Removal Matters
The structured order for removing PPE is designed to isolate and discard the most heavily contaminated items first. This strategy minimizes the risk of the wearer’s skin or clothing contacting the outer, exposed surfaces of the gear. Removing the most soiled components first establishes a clean-to-dirty flow, preventing the transfer of pathogens.
The exterior of items like gloves and gowns are considered the highest contamination zones because they have been in direct contact with the environment. Managing these layers first systematically reduces the microbial burden before touching the face or head. The goal is to create a clean boundary, allowing the wearer to safely access and remove the items protecting the respiratory system and eyes.
Step-by-Step Doffing Sequence
Gloves
The removal process must begin with the gloves, the piece of equipment most likely to be heavily contaminated from direct contact. To remove them safely, grasp one glove near the cuff and peel it off inside out, holding the removed glove in the palm of the remaining gloved hand. Peel off the second glove by sliding an ungloved finger under the cuff. Turn the entire bundle inside out to contain all contamination, and discard it immediately.
Gown
After the gloves are removed, the next item is the gown. Remove the gown by untying the neck and waist fasteners, then pulling it away from the shoulders. Peel it off while turning the contaminated outer surface inward. The wearer should only touch the inside, clean surface of the gown, rolling it into a bundle before disposal.
Hand Hygiene Interruption
A mandatory interruption for hand hygiene follows the removal of the gloves and gown. This step cleans the hands of any contaminants that may have touched the skin during the first two steps. This is done with an alcohol-based hand rub or soap and water before proceeding to touch any remaining gear.
Eye Protection
Next, the eye protection, such as goggles or a face shield, is removed by handling only the clean headband or earpieces. The wearer must avoid touching the front surface of the eye protection, as this is considered contaminated. If the item is reusable, it is placed in a designated receptacle for reprocessing; otherwise, it is discarded.
Mask or Respirator
The mask or respirator is the final piece of PPE to be removed, as it has protected the wearer’s airway and mucous membranes throughout the process. Remove the mask by grasping the bottom ties or elastics first, followed by the top ones. Do not touch the front portion of the mask, and discard it into the appropriate waste container.
Essential Steps After Removal
The process is not complete until the wearer performs a final hand hygiene procedure immediately after the mask is discarded. This step removes any final traces of contamination. Hands should be washed with soap and water for at least 20 seconds, ensuring all surfaces are scrubbed completely. Alternatively, an alcohol-based hand sanitizer can be used. All contaminated items must be disposed of correctly into designated waste receptacles immediately following their removal. This ensures that the infectious materials are contained and do not pose a risk to others.