5.1 PPE Selection, Performance Standards, and Sequences

PPE Selection, Donning, and Doffing

PPE is selected from the anticipated exposure, not from the procedure name alone. OSHA requires the employer to provide appropriate PPE in suitable sizes at no cost to employees, train them, and clean, repair, replace, and dispose of employer-provided PPE. Contaminated protective clothing does not go home with the worker.

Masks and Respirators

A medical procedure mask protects the nose and mouth from splash, spray, and droplets and helps contain wearer secretions. Choose its fluid resistance and other performance characteristics for the anticipated exposure and the product labeling. ASTM F2100 levels describe mask-material performance, but the standard does not by itself command “Level 3 for every aerosol procedure.”

Change a mask between patients and sooner if wet, visibly soiled, damaged, or difficult to breathe through. Remove it by ties or ear loops without touching the front. A face shield does not replace a mask because it is open around the edges.

A surgical mask is loose fitting and is not a substitute for a respirator when respiratory protection is required. A NIOSH-approved respirator is selected through the employer’s hazard assessment and used within an OSHA respiratory-protection program.

Eye and Face Protection

Dental procedures can project blood, saliva, calculus, fragments, and chemicals. Wear protective eyewear with solid side protection or a face shield when splash, spray, or debris is anticipated. A face shield adds broad facial coverage but is normally used with a mask or respirator appropriate to the inhalation and splash hazard.

Ordinary prescription glasses may lack side coverage and rated impact protection. Prescription safety eyewear that meets the applicable performance criteria can be appropriate; otherwise use goggles or a shield over personal glasses. Provide patient eye protection for procedure-related debris and splash. Clean and disinfect reusable eye and face protection between patients according to the manufacturer’s IFU.

Protective Clothing

Wear a gown, clinic jacket, or other garment with coverage and fluid resistance suited to the expected exposure. OSHA requires effective protection but does not prescribe a universal mandarin collar, knit cuff, or AAMI level for every dental task. Remove the garment as soon as feasible if blood or OPIM penetrates it and change it when visibly contaminated. Keep contaminated clothing within the work area and employer-controlled laundry or disposal process.

Gloves

• Examination gloves: single-use patient-care barriers for contact with blood, saliva, mucosa, nonintact skin, or contaminated items. Change between patients and between dirty and clean tasks when contamination would spread.
• Sterile surgeon gloves: used for oral surgical procedures. Perform surgical hand antisepsis first.
• Heavy-duty utility gloves: reusable task gloves for instrument cleaning, contaminated-sharp handling, and chemical or housekeeping work when the hazard assessment and product label call for puncture or chemical resistance. Reprocess them only as their IFU permits and replace them when cracked, peeling, punctured, or otherwise damaged.

Never wash or disinfect patient examination or surgeon gloves for reuse. Remove gloves promptly after the task, avoid touching clean environmental surfaces with contaminated gloves, and perform hand hygiene immediately afterward. Double gloving or glove material selection may be used for a specific task, allergy, or surgical policy, but it does not replace safe sharps technique.

Donning

A common sequence is hand hygiene, protective clothing, mask or respirator, eye/face protection, then gloves. For a tight-fitting respirator, complete required fit testing beforehand and perform a user seal check every time it is donned. Pull gloves over gown cuffs when the garment and task are designed for that overlap.

The exact sequence can vary with the PPE ensemble. Follow the facility’s trained method and the device IFUs. The goal is full coverage without contaminating clean PPE during placement.

Doffing

PPE exteriors are contaminated. Remove them without touching skin, clothing, or mucous membranes with the contaminated surfaces. One accepted sequence is gloves, gown, eye protection, mask or respirator, then hand hygiene. CDC also illustrates removing gown and gloves together. Respirators may be removed after leaving the patient room in an airborne-isolation workflow, according to the facility protocol.

Key principles are more durable than memorizing one order:

1. Remove the most contaminated items without snapping or shaking.
2. Handle eye protection by clean earpieces or straps and send reusable equipment for cleaning/disinfection.
3. Handle masks and respirators only by ties or straps.
4. Keep contaminated apparel inside the designated work area.
5. Perform hand hygiene immediately after all PPE is removed and sooner if hands become contaminated during doffing.

PPE Failure

If a glove tears, stop safely, remove it, perform hand hygiene, and don a new glove. If blood or saliva penetrates clothing or reaches skin or mucosa, remove the affected PPE, wash or flush the site, and apply the exposure-control plan. Document and obtain medical evaluation when the event meets the definition of an occupational exposure.

The exam-safe rule is: match PPE to the hazard, use it correctly, remove it without self-contamination, and perform hand hygiene.