How To Put On Ppe Correct Donning Sequence? Key Facts

Putting on personal protective equipment (PPE) in the correct order is a critical skill for healthcare workers and anyone handling infectious materials. The standard donning sequence is: perform hand hygiene, put on the gown, then the mask or respirator, followed by eye protection, and finally the gloves. This specific order is designed to reduce the risk of self-contamination and exposure to pathogens. When removing PPE, the order changes entirely to protect you from touching contaminated surfaces with bare hands.

Why Is the PPE Donning Sequence So Important?

The order in which you put on PPE is not random. Each step protects a specific part of your body, and the sequence ensures that the last thing you touch before patient contact is your gloves. This keeps your hands clean for as long as possible and prevents contamination of your clothing or skin while you are gearing up.

If you put gloves on before your gown, you risk touching the outside of the gown with a gloved hand that may have picked up contaminants. The sequence also ensures that your mask and eye protection are correctly positioned before your gloves are on, so you do not have to adjust them with potentially contaminated hands later.

Step-by-Step Guide: How to Put on PPE Correctly

This is the standard sequence recommended by major health organizations. Follow these steps in order every time you enter a room requiring contact precautions or droplet precautions.

Step 1: Perform Hand Hygiene

Clean your hands with an alcohol-based hand sanitizer or wash with soap and water. This is the foundation of the entire process. Your hands must be clean before you touch any PPE.

Step 2: Put on the Gown

Select the appropriate gown for the task. Put it on so that it fully covers your torso, from your neck to your knees, and your arms to the ends of your wrists. Fasten it at the back of your neck and waist. The gown protects your clothing and skin from contamination.

Step 3: Put on the Mask or Respirator

Place the mask over your nose and mouth. Secure the ties or elastic bands. Mold the metal nose piece to the shape of your nose. If using an N95 respirator, perform a fit check by placing both hands over the mask and exhaling sharply to check for air leaks. The mask protects your nose and mouth from droplets and airborne particles.

Step 4: Put on Eye Protection

Place goggles or a face shield over your eyes. Ensure it fits snugly and does not fog up your vision. This protects your eyes from splashes, sprays, and respiratory droplets.

Step 5: Put on Gloves

Gloves go on last. Pull them over the cuffs of your gown so that no skin is exposed at the wrist. The gloves protect your hands and prevent you from touching contaminated surfaces with bare skin.

Common Mistakes to Avoid During Donning

Even experienced professionals make errors. The most common mistakes include touching the outside of the mask while adjusting it, putting gloves on before the gown, and failing to cover the gown cuffs with the gloves. Any break in this sequence can increase your risk of exposure.

Another frequent error is wearing jewelry or a watch. These items can tear gloves and collect contaminants. Remove all jewelry before starting the donning process.

Long hair should be tied back and kept off your face and shoulders. If you have a beard, an N95 respirator cannot form a proper seal. A loose-fitting surgical mask is the appropriate choice in that case.

How to Remove PPE Safely (Doffing Sequence)

Removing PPE is where most self-contamination occurs. The doffing order is different from donning. The gloves are considered the most contaminated items and are removed first.

The removal sequence is: gloves, then eye protection, then gown, then mask. Hand hygiene is performed immediately after removing each piece.

Removing Gloves

Grasp the outside of one glove at the wrist. Peel it off, turning it inside out. Hold the removed glove in your gloved hand. Slide two fingers of your bare hand under the cuff of the remaining glove and peel it off, turning it inside out. Discard both gloves immediately.

Removing Eye Protection

Handle goggles or a face shield by the headband or earpieces only. Do not touch the front of the eye protection. Pull it away from your face and discard it. The front of the eye protection may be contaminated with droplets.

Removing the Gown

Untie the gown at the waist and neck. Reach behind and pull the gown off your shoulders without touching the front of the gown. Turn the gown inside out as you remove it. Discard it. The front of the gown is the most contaminated part.

Removing the Mask

The mask is removed last. Touch only the ties, ear loops, or straps. Do not touch the front of the mask. Pull it away from your face and discard it. Perform hand hygiene immediately after removing the mask.

What Is the Difference Between a Surgical Mask and an N95 Respirator?

A surgical mask is loose-fitting and protects against large droplets, splashes, and sprays. It does not provide a reliable seal against airborne particles. An N95 respirator is tight-fitting and filters at least 95% of airborne particles. It requires a fit test to ensure a proper seal.

The choice between them depends on the situation. For routine patient care with no aerosol-generating procedures, a surgical mask is typically sufficient. For procedures that generate aerosols, such as intubation or bronchoscopy, an N95 respirator is recommended. The donning sequence is the same for both, but the N95 requires a fit check after placement.

Does the Sequence Change for Different Types of PPE?

The core sequence remains the same for most situations: gown, mask, eye protection, gloves. However, some facilities use different PPE combinations depending on the transmission route of the pathogen.

For airborne precautions, you may use an N95 respirator instead of a surgical mask. For contact precautions, you may add a waterproof apron over the gown. In all cases, the order of donning remains gown first, then respiratory protection, then eye protection, then gloves.

If you are wearing a powered air-purifying respirator (PAPR), the sequence changes. The PAPR hood is put on first, followed by the gown, then the gloves. Always follow your facility’s specific protocol for specialized equipment.

How Long Does Proper Donning Take?

With practice, donning PPE takes about one to two minutes. Rushing through the process increases the risk of errors. Take your time. Check each item as you put it on. A small mistake can have serious consequences when dealing with infectious diseases.

Many healthcare facilities require a buddy system where a colleague watches you don and doff PPE and checks for any gaps in coverage. This practice is especially important in high-risk settings. If your facility uses this system, cooperate fully. An extra set of eyes can catch a mistake you might miss.

Training and Practice Are Essential

Reading about PPE is not the same as practicing it. Muscle memory matters. You should practice the donning and doffing sequence until it becomes automatic. Many facilities hold regular training sessions where staff practice with actual PPE.

Studies have shown that healthcare workers who practice PPE donning and doffing make fewer errors than those who only read about it. If you have access to training supplies, use them. Practice in front of a mirror or with a colleague. Check that every piece of PPE fits correctly and covers all exposed skin.