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Putting on and taking off personal protective equipment

  • Procedure

Putting PPE on and taking it off in the right order protects against self-contamination, which happens mostly during removal.

Updated

What it is

Personal protective equipment (PPE) only protects if it is put on and taken off correctly. The CDC's order for putting it on is: gown, mask or respirator, goggles or face shield and, last, gloves. Removal starts with the most contaminated item: gloves, goggles or face shield, gown and, last, the mask or respirator, with hand hygiene immediately afterwards. All PPE comes off before leaving the room except the respirator, which is removed outside with the door closed. An institution may adopt another validated sequence; what matters is following it the same way every time.

Indications

  • Expected exposure to blood, fluids, secretions or excretions.
  • Care of patients on contact, droplet or airborne precautions.
  • Procedures that may splash or generate aerosols.
  • Handling soiled equipment or linen.

Contraindications and precautions

  • An N95 respirator requires prior fit testing and a seal check every time it is put on.
  • With a latex allergy, use latex-free gloves.
  • Put PPE on in the clean area, outside the room.
  • Change torn or heavily contaminated PPE at once.
  • Disposable gloves and gowns are not reused.

Equipment

  • Isolation gown in your size.
  • Surgical mask or N95 respirator, according to the precaution.
  • Protective goggles or face shield.
  • Non-sterile gloves of the correct size.
  • Alcohol-based hand rub or a sink with soap and water.
  • Waste container and a reprocessing container for reusable goggles or face shields.

Step by step (and why)

  1. Perform hand hygiene and gather the PPE the precaution requires — so you do not leave mid-process to fetch something.
  2. Put on the gown: cover neck to knees and arms to wrists; tie it at the neck and waist — it protects skin and clothing.
  3. Put on the mask or respirator: fit the nose band and cover to below the chin; check the seal — a leak cancels the protection.
  4. Put on goggles or face shield and then gloves, over the gown cuffs — gloves go last so they are not contaminated.
  5. During care, keep hands away from your face, work from clean to dirty and touch few surfaces — it limits self-contamination.
  6. Remove gloves: grasp one on the outside, peel it off, hold it and remove the other from inside the wrist — gloves are the most contaminated.
  7. Remove goggles or face shield by the band or ear pieces — the front is contaminated.
  8. Remove the gown: untie it, pull it from the shoulders turning it inside out and roll it inward — the front and sleeves are contaminated.
  9. Remove the mask by the bottom ties, then the top, without touching the front; the respirator, outside with the door shut — the front is contaminated.
  10. Perform hand hygiene immediately, and between steps if hands become contaminated — it is the last barrier against self-contamination.

Complications

  • Self-contamination of hands, face or clothing when PPE is removed out of order.
  • Respiratory exposure through a respirator that does not seal.
  • Exposure of the wrist skin if gloves do not cover the gown cuffs.
  • Allergic reaction to latex gloves.

Next step: when to call for help

  • If a glove tears or there is a splash to the eyes, nose or mouth: leave, remove PPE, wash or irrigate the area and report it as a biological exposure.
  • If suitable PPE is missing or the respirator does not seal, do not go in and tell the nurse in charge.
  • If a colleague's PPE is on wrongly or torn, tell them before they go in.
  • If you do not have a current respirator fit test, tell occupational health before caring for patients on airborne precautions.

Test yourself

Think of the answer, then tap the question to see it.

In what order is personal protective equipment put on according to the CDC?

Gown, mask or respirator, goggles or face shield and, last, gloves over the gown cuffs.

Why are gloves removed first?

Because they are the most contaminated. Removing them first stops gloved hands from contaminating the face or clothing while removing the rest.

Where is an N95 respirator removed?

Outside the room, after closing the door. The rest of the PPE comes off before leaving.

How is a mask removed without self-contamination?

By grasping the bottom ties or elastics first, then the top ones, without touching the front, and discarding it. Hand hygiene follows.

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Appendix A: Figure. Example of Safe Donning and Removal of Personal Protective Equipment (PPE) (Centers for Disease Control and Prevention (CDC), 2007); Sequence for Putting On and Removing Personal Protective Equipment (PPE) (Centers for Disease Control and Prevention (CDC), 2014); Nursing Skills, 4.7 Checklist for Personal Protective Equipment (PPE) (Open RN, Wisconsin Technical College System (LibreTexts copy, CC BY 4.0), 2021); Latex Allergy: A Prevention Guide (Publication 98-113) (CDC / National Institute for Occupational Safety and Health (NIOSH), 1998).

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Representative model, for educational purposes only.