The Ins and Outs of Donning and Doffing PPE

by Gracie Hogue, BM

Did you know that your policies should include PPE donning and doffing procedures? When it comes to PPE, the sequence of donning and doffing is just as important as the PPE you’re wearing. Following the proper sequence can save you time and aid your efforts in fighting the spread of infection.

Sequence for donning (putting on) PPE:

1. Gowns: Be sure that the gown covers your torso from neck to knees, and that the sleeves reach comfortably to the end of your wrists, and that the wrap around the back is completed without gaps. Identify the proper PPE to don for the treatment care you are about to execute. Ensure choice of gown size is correct (based on training). Once the gown is donned, wash hands and/or use hand sanitizer. Don the isolation gown if necessary. Ask for any assistance needed when donning a gown to ensure that it is properly fitted and clasped.
2. Masks and Respirators:a. Masks: Secure ties or elastic bands behind your ears or around the back of your head. Don’t twist the ear loops as this creates gaps. Fit the flexible band to the bridge of your nose and ensure that the bottom of the mask fits snugly under the chin. Do not pull the mask down under your chin when taking a moment’s break as this compromises the mask. Never reuse the mask after it has left the fitted position on your face.

b. Respirators: Be sure that you have had a medical evaluation before your initial fit testing of your respirator. Have the respirator properly fit tested so there are no gaps or potential exposures around the face, jaw, or chin. Respirator straps should be placed on crown of head (top strap) and base of neck (bottom strap). Perform a user seal check each time you put on the respirator.

3. Goggles or Face Shield: Place the goggles or face shield over your face and adjust the band around your head to fit snugly.
4. Gloves: Put on gloves and extend them to wrists. Be sure that no skin at the wrists or arms is exposed. If a glove is torn or compromised, change pairs. Avoid having long fingernails or wearing large hand jewelry so that gloves fit properly and risk of their being compromised is kept at a minimum.

Remember overall: Keep your hands away from your face, limit the number of surfaces touched, and perform hand hygiene.

Sequence for doffing (taking off) PPE:

1. Gowns and Gloves: Remember that the gown’s front and sleeves are contaminated, so begin taking off the gown off while your gloves are still on so any contamination does not get on your bare hands. Grasp the gown in the front and pull away from your body. As the gown is being removed, loosen your gloves by the fingertips so they are easily removed at the same time as the gown. If your gown is tied in the back, remove gloves first, then untie the back ties to remove gown, pulling it off at the back forward. If your gown is disposable, roll the gown inside out in a bundle along with the gloves being removed so your bare hands only touch the least contaminated/inside part of the gown. If your gown is washable, drop the gloves into a waste container marked with a biohazardous label, then shed the gown and roll it into a bundle inside out. Avoid hand contact with the contaminated parts of the gown. If your hands come in contact with contamination, wash your hands. Once your gown and gloves are removed, you may exit the patients’ treatment room.
2. Goggles or Face Shields: Be aware that the goggles and face shield is contaminated, so handle in such a way as to avoid as much contact with the contamination as possible. Remove from the back by lifting the headband. Do not touch the front of the goggles or face shield. If the items are reusable, place them in the designated area or tray for them to be reprocessed. If they are disposable, discard in a waste container marked with a biohazardous label.
3. Masks and Respirators: Be aware the mask or respirator is contaminated, so do your best to avoid touching the front. Take the bottom ties or bands and then the top bands and remove without touching the front. Once masks or respirators are removed, perform hand hygiene.

Remember overall: Use hand hygiene thoroughly and use an alcohol-based hand sanitizer immediately after doffing all the PPE. When washing hands, wet hands thoroughly, add soap, and scrub. Scrub all crevices and creases in the hand that are easily missed for at least 20 seconds (if you need a helpful self-timer, sing the “Happy Birthday” song twice!). Rinse your hands thoroughly in running water and dry your hands on a clean towel or paper towel.

Work on memorizing this sequence so you can effectively don and doff in such a way as to reduce possible spread of infection.

Also reference the CDC’s Guidance for donning and doffing PPE here: https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html