PPE Donning and Doffing Sequences

Correct PPE sequencing is a high-priority topic on the NCLEX. The order matters because improper technique leads to self-contamination, defeating the purpose of wearing PPE.

The Logic Behind the Sequences

Donning (putting on): Start with items closest to your body and work outward. You put on clean items before touching potentially contaminated surfaces.

Doffing (taking off): Remove the most contaminated items first while keeping your face protected longest. The gloves touch everything contaminated; the mask protects your airway.

---

Donning Sequence: Putting ON PPE

Remember: "Go Get My Eyewear, Gloves" or work from inside to outside.

Detailed Donning Steps

1. Hand Hygiene

   • Use alcohol-based hand rub or soap and water
   • Ensure hands are completely dry before proceeding

2. Gown

   • Select appropriate size
   • Opening in the back
   • Secure at neck and waist
   • Gown should fully cover torso

3. Mask/Respirator

   • For surgical mask: secure ties or ear loops
   • For N95: perform seal check (positive and negative pressure tests)
   • Mask should cover nose, mouth, and chin

4. Eye Protection

   • Place goggles or face shield over face and eyes
   • Adjust to fit securely

5. Gloves

   • Select appropriate size
   • Insert hands into gloves
   • Extend glove cuffs OVER gown cuffs (no exposed skin)

---

Doffing Sequence: Taking OFF PPE

Remember: "Gloves, Eyes, Gown, Mask" or work from outside to inside (contaminated to clean).

Detailed Doffing Steps

1. Remove Gloves

   • Grasp outside of one glove with opposite gloved hand
   • Peel off, turning inside out
   • Hold removed glove in gloved hand
   • Slide fingers of ungloved hand under remaining glove at wrist
   • Peel off, turning inside out over first glove
   • Dispose in waste container
   • Perform hand hygiene

2. Remove Goggles/Face Shield

   • Handle by headband or earpieces (considered "clean")
   • Do NOT touch front of goggles
   • Place in designated area for reprocessing or dispose

3. Remove Gown

   • Untie ties (or break if ties are in back)
   • Pull gown away from neck and shoulders
   • Turn inside out
   • Fold or roll into a bundle
   • Dispose in waste container
   • Perform hand hygiene

4. Remove Mask/Respirator

   • Do NOT touch the front of the mask
   • For surgical mask: untie bottom tie first, then top; remove by ties
   • For N95: remove bottom strap first, then top strap
   • Dispose in waste container
   • Perform hand hygiene

---

Critical Safety Points

Gloves First During Doffing

Gloves are the most heavily contaminated PPE item. They touch:

• The patient
• Contaminated surfaces
• Body fluids and secretions

Removing gloves first prevents contaminating other PPE or your face during the rest of the doffing process.

Mask Last During Doffing

The mask protects your respiratory tract-your most vulnerable entry point for pathogens. Keeping it on until last provides maximum airway protection throughout doffing.

For Airborne Precautions

The mask/respirator is removed outside the room after closing the door. This is because airborne particles remain suspended in the room air.

---

Common Doffing Errors

---

PPE Based on Precaution Type

---

Practice Scenario

A nurse is preparing to enter the room of a patient on contact and droplet precautions.

Donning sequence:

1. Hand hygiene
2. Gown
3. Surgical mask
4. Goggles
5. Gloves

Doffing sequence (inside room):

1. Gloves (dispose, hand hygiene)
2. Goggles (to reprocessing)
3. Gown (dispose, hand hygiene)
4. Mask (dispose)
5. Hand hygiene

---

On the NCLEX

Expect questions asking:

• Which PPE item is removed first/last?
• What is the correct sequence for donning/doffing?
• Why is the mask removed last?
• Where is the N95 removed for airborne precautions?

Exam Strategy: Visualize actually putting on and taking off PPE. The sequence makes logical sense once you think about contamination levels.