| FAQ - Personal Protective Equipment (PPE) - 2015
Can you please clarify the correct way to teach donning and doffing of PPE? I stress that gloves should always be the last item of PPE to be put on and that the order of removal varies depending on what is the most contaminated being removed first, and stressing the importance of preforming hand hygiene both before and after PPE placement and removal.
The sequence for donning and removing Personal Protective Equipment (PPE) do vary slightly. Ask OSAP can provide you with general information, but the combination of PPE selected can affect the sequence for donning and removing. What is important is to put on and take off PPE in a manner that minimizes further spread of contamination.
OSAP’s publication, Infection Control In Practice- Personal Protective Equipment February 2003 provides the following information:
Don patient-care PPE in the reverse order of what you change the most during the course of the clinic day. Gloves are changed most often, face protection less often, and clothing least often of all. 1
1. First put on protective clothing over your uniform, street clothes, or scrubs. Appropriate protective apparel includes lab coats, clinic jackets, and gowns.
2. Don protective eyewear (for example, safety glasses with side shields, goggles, or face shields).
3. Add face protection (face mask).
4. Finally, when ready to begin the procedure, wash and thoroughly dry your hands. (When hands are not visibly soiled, an alcohol-based hand rub can be used in lieu of handwashing.) Holding one glove at the cuff, place the opposite hand inside the glove and pull it onto the hand. Adjust for fit. Repeat with a new glove on the other hand. 1
1. Use your gloved hand to grab the other glove at the outside cuff. Pull downward, turning the glove inside-out as it pulls away from your hand.
2. For the other hand, use your ungloved fingers to grab the inside (uncontaminated area) of the cuff of the remaining glove. Pull downward to remove the glove, turning it inside out.
3. Wash and thoroughly dry hands before re-gloving. (If no visible contamination exists, CDC allows an antiseptic hand rub in lieu of handwashing. If hands are damp with perspiration or to remove glove powder and chemicals, handwashing and rinsing may be preferred.) 1
Change masks between patients or when they become damp from external contamination or from condensation of moist, exhaled air (about every 20 minutes).
When wearing gloves, hold mask by the body to remove. Ungloved, contact only mask’s ties or elastic strap. 1
Process reusable eye and face protection between patients.
1. With gloves in place, remove protective eyewear (glasses, goggles, face shields). If you need to put them down, put them on a disposable towel out of the way.
2. If contaminated with blood, disinfect according to the manufacturer’s instructions; if not wash with soap and water. 1
To remove visibly soiled clothing:
1. Fold the soiled area away from the body; be careful not to contaminate your hands. Discard (disposable) or place into the designated container for contaminated laundry (reusable garments). 1
Infection Control & Management of Hazardous Materials for the Dental Team suggests the following:
Putting on and Removing Equipment
1) Protective clothing
3) Protective eyewear
1) Disposable gown
3) Protective eyewear
4) Mask 2
The authors of Practical Infection Control in Dentistry offer a different sequence for donning and removal of PPE. They suggest the following:
1) Protective Clothing
3) Protective eyewear
2) Protective eyewear
3) Protective clothing
4) Mask 3
The US Centers for Disease Control and Prevention (CDC) provides a poster and PowerPoint presentation that explains the recommended sequence for donning and removing PPE: More information can be accessed at this link:
It states the following:
Sequence for Donning PPE
3) Goggles/Face Shield (Eyewear)
Sequence for Removing PPE
2) Goggles/Face Shield/ (Eyewear)
4) Mask 4
In summary, while there may be some variation in recommended procedures for donning and removing PPE, what is important to remember is to put on and take off PPE in a manner that minimizes the further spread of contamination.
1) Organization for Safety, Asepsis and Prevention. Infection Control In Practice: Putting It All Together – Personal Protective Equipment Vol. 2, No. 2 February 2003. http://c.ymcdn.com/sites/www.osap.org/resource/resmgr/publications/personal_protective_equipmen.pdf Accessed on September 2, 2015.
2) Miller CH. Infection Control and Management of Hazardous Materials for the Dental Team, 5th edition. Elsevier/Mosby Publishers. Page 117.
3) Molinari JA and Harte JA. Practical Infection Control In Dentistry – Third Edition. Wolters Kluwer / Lippincott / Williams & Wilkins. Pages 112-113.
4) US Centers for Disease Control and Prevention.Tools for Protecting Healthcare Personnel. http://www.cdc.gov/HAI/prevent/ppe.html Accessed on September 2, 2015.