PPE Selection, Donning, Doffing & Maintenance

Select PPE from the hazard

PPE is the final barrier in a layered control system. The employer assesses the tasks and provides PPE in appropriate sizes at no cost. During routine patient care, gloves protect hands when contact with blood, saliva, mucosa, non-intact skin, or contaminated items is reasonably anticipated. A surgical mask protects the nose and mouth from splash and spray within its intended use. Protective eyewear with solid side protection—or a face shield worn with a mask—protects mucous membranes. Protective clothing covers skin and personal clothing likely to be exposed.

Select more protection when the task creates more splash, spray, chemical, heat, or sharps risk. Instrument processing commonly calls for reusable utility gloves with puncture and chemical resistance, protective clothing, and face/eye protection. The correct glove material comes from the chemicals handled and the glove and product instructions; “nitrile” is not a universal answer for every disinfectant or cleaner.

Respirators serve a different function from surgical masks. When a workplace requires respirator use for an airborne hazard, OSHA's respiratory-protection requirements include a written program, medical evaluation before required use, fit testing, training, and seal checks. A face shield cannot substitute for either a mask or respirator.

Put on clean protection

Before donning PPE, remove unnecessary jewelry, secure hair if needed, inspect the equipment, and perform hand hygiene. A practical sequence is protective clothing first, mask or respirator next, eye protection or face shield next, and gloves last. Pull gloves over gown cuffs when the design and task require coverage. If a respirator is required, conduct the user seal check each time it is donned.

Sequence is a tool, not the only objective. The critical outcome is that clean PPE is applied without contamination and all exposed skin and clothing areas likely to encounter the hazard are covered. Do not wear the same patient-care gloves in hallways, offices, or clean supply areas.

Remove without transferring contamination

The outside of gloves, protective clothing, masks, and eye protection may be contaminated. A common clinical sequence removes gloves first, then eye protection or face shield by clean straps or earpieces, then protective clothing by rolling the contaminated side inward, and then the mask by ties or elastics. Facility protocols can adapt the order to the PPE design and room; avoid touching the front of the mask, shield, or gown.

Perform hand hygiene immediately after glove removal. If the hands become contaminated during another removal step, clean them again. After all PPE is removed, perform hand hygiene before touching clean objects. Reusable eye protection and face shields are cleaned and disinfected between users or patients according to the manufacturer instructions. Disposable items are not reprocessed unless their labeling specifically permits it.

Replacement and employer duties

Change masks between patients or sooner when wet, visibly soiled, damaged, or difficult to breathe through, following manufacturer and facility policy. Change gloves between patients and after tears or task changes. Remove protective clothing before leaving the work area when it is penetrated or contaminated and place it in the designated container.

Under the Bloodborne Pathogens Standard, the employer cleans, launders, repairs, replaces, or disposes of required PPE. Employees must not take contaminated protective garments home. Contaminated laundry is handled as little as possible, bagged or contained where used, and labeled or color-coded as required. Laundry workers receive appropriate protection.

Reusable utility gloves can be decontaminated for reuse if their integrity is not compromised and the manufacturer permits it. Discard them when cracked, peeling, punctured, torn, or no longer protective. Examination and surgical gloves are single-use.

Question strategy

When options name several PPE combinations, identify the actual exposure. Splash to the face calls for mask plus eye protection or a shield that supplements the mask. Handling contaminated sharps during cleaning calls for utility gloves and splash protection, not thin patient-exam gloves alone. An airborne-isolation scenario may require a respirator program rather than simply adding a second surgical mask. PPE never excuses unsafe work practices, hand hygiene, source control, or engineering controls.

Preserve clean and contaminated zones

Store clean PPE away from splash, sinks, and contaminated processing. Do not keep masks in pockets between patients or hang a used gown beside clean garments. Put reusable eye protection into a designated contaminated container until it is processed; do not place it on a clean counter.

Fit affects protection. Gloves that are too small tear and restrict movement, while oversized gloves reduce control. Eyewear must protect from the direction of splash and not leave obvious side gaps. Protective clothing should cover the areas likely to be exposed and be removed before leaving the work area when contaminated.

If PPE is penetrated by blood, remove it as soon as feasible without increasing exposure, wash affected skin, and report any qualifying contact with mucosa or non-intact skin. Replacing PPE is not the end of the response if an exposure incident occurred.

Quick decision sequence

• Anticipate the exposure before selecting PPE.
• Inspect, don, and use each item within its intended function.
• Remove without self-contamination, process reusable items, and perform hand hygiene.