10.2 Donning & Doffing Sequence
Key Takeaways
Donning order: shoe covers, first (inner) gloves, gown, second (outer) gloves pulled over the gown cuffs, then head/hair cover, mask/respirator, and eye protection as needed for the task
Outer gloves go OVER the gown cuff, not under it, to eliminate any gap of exposed skin at the wrist - this is the most commonly missed detail on the exam
Doffing order: outer gloves first (most contaminated), gown rolled inward away from the body, inner gloves removed last, then head cover/mask/eye protection, then immediate hand hygiene
Inner gloves are removed last because hands may carry residual contamination on the outer glove surface throughout the task, so keeping that barrier on protects the hands the longest
The universal doffing rule tested across scenario questions: the contaminated outer surface of any PPE item must never touch bare skin during removal
Donning and Doffing Sequence for Hazardous Drug PPE
The order in which personal protective equipment (PPE) is put on (donned) and taken off (doffed) is not arbitrary - it exists to prevent a two-way contamination pathway: keeping HD residue off the technician's skin while donning, and preventing PPE that became contaminated during a task from touching skin or clothing while doffing. This is one of the most heavily tested sequencing topics in the PPE domain (13% of the exam), because it rewards precise step-by-step recall rather than general familiarity with PPE items.
Guiding Principle
Donning proceeds from least contaminated to most contaminated - items that will end up closest to the technician's skin and hardest to fix later (like the gown cuff/wrist seal) go on before the items that lock them in place. Doffing reverses that logic but adds a second rule: remove the most contaminated item first, and never let the outside (contaminated) surface of any PPE item touch bare skin during removal.
Donning Sequence (Putting On)
| Step | Item | Why This Order |
|---|---|---|
| 1 | Shoe covers | Lowest contamination risk; done first, before handling any other PPE |
| 2 | First (inner) pair of gloves | Establishes a base hand barrier before the gown goes on |
| 3 | Gown | Body barrier; put on before the outer gloves so its cuffs can be tucked underneath them |
| 4 | Second (outer) pair of gloves | Pulled over the gown cuffs, sealing the wrist - the critical control point that eliminates any gap of exposed skin |
| 5 | Head/hair cover, mask or respirator, and eye protection (as needed for the task) | Donned last, closest to the face/airway, and selected based on the specific task's respiratory and splash risk |
The step that most often trips up candidates is step 4: the outer glove goes over the gown cuff, not under it. Tucking the gown cuff underneath the outer glove means there is no exposed skin at the wrist even if the technician's arm moves during compounding or spill response.
Doffing Sequence (Taking Off)
Doffing is the reverse order, but the reasoning is about contamination containment rather than a simple inversion of steps:
| Step | Item | Why This Order |
|---|---|---|
| 1 | Outer gloves (most contaminated item) | Removed first because they had the most direct contact with HD residue; peeled off without letting the outer surface touch skin |
| 2 | Gown | Rolled inward, away from the body, so the contaminated exterior surface folds in on itself and never contacts skin or clothing |
| 3 | Inner gloves (removed last) | Hands may retain residual contamination on the outer surface of the inner gloves throughout the procedure, so keeping this barrier on as long as possible protects the hands until the very end |
| 4 | Head/hair cover, mask/respirator, eye protection | Removed after the higher-contamination-risk items |
| 5 | Hand hygiene | Performed immediately after all PPE is removed, regardless of how carefully the technician doffed |
The Core Doffing Rule
When a scenario question asks about doffing technique rather than a specific step order, the underlying principle being tested is almost always the same: the outside (potentially contaminated) surface of any PPE item must never touch bare skin during removal. This is why the gown is rolled inward rather than pulled off overhead, and why gloves are peeled from the wrist rather than grabbed by the outer surface.
Worked Scenario
A technician finishes compounding a hazardous injectable drug inside a BSC and steps back to a designated doffing area outside the C-PEC to remove PPE. The correct first move is to remove the outer gloves - not the gown, and not the inner gloves - because the outer gloves have had the most direct contact with the HD and any surfaces touched during compounding. After the outer gloves are removed and discarded, the technician rolls the gown inward and away from the body, then removes the inner gloves last, followed by the head cover, mask, and eye protection, and finally performs hand hygiene. If the technician instead removed the gown first while the outer gloves were still on, exposed skin at the wrist (from arm movement during the reach) could brush the contaminated gown surface - exactly the failure mode the sequence is designed to prevent.
Key Takeaways
- Donning order: shoe covers, first (inner) gloves, gown, second (outer) gloves over the gown cuffs, then head cover/mask/respirator/eye protection
- Outer gloves go OVER the gown cuff, not under it, to eliminate any gap of exposed skin at the wrist
- Doffing order: outer gloves first (most contaminated), gown rolled inward, inner gloves last, then head cover/mask/eye protection, then hand hygiene
- Inner gloves are removed last because they protect the hands the longest against residual contamination accumulated during the task
- The universal doffing rule: the contaminated outer surface of any PPE item must never touch bare skin during removal
In what order should a technician don shoe covers, the first (inner) pair of gloves, and the gown before compounding a hazardous drug?
Shoe covers, first (inner) gloves, gown
Gown, shoe covers, first (inner) gloves
First (inner) gloves, gown, shoe covers
Shoe covers, gown, first (inner) gloves
Why are the outer (second) pair of gloves pulled over the gown cuffs rather than tucked underneath them?
To make removal faster at the end of the procedure
To eliminate any gap of exposed skin at the wrist by sealing the gown cuff underneath the outer glove
Because USP <800> requires a specific glove brand for the outer layer
Because the gown cuff material is not compatible with tucking
When doffing contaminated PPE after handling a hazardous drug, which item is removed FIRST, and why?
Inner gloves, because they touch the skin directly
Gown, because it is the largest item and easiest to remove first
Outer gloves, because they are the most contaminated item and must come off before anything else is touched
Head/hair cover, because it is farthest from the hands
A technician has just removed the gown during doffing by rolling it inward away from the body. What should happen next in the correct doffing sequence?
The inner gloves should already have been removed before the gown
The inner gloves should be removed at the same time as the gown
The inner gloves should be discarded without performing hand hygiene afterward
The inner gloves should remain on until the very end, removed last, followed immediately by hand hygiene
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