PPE Donning & Doffing

In this video we’re going to talk about donning and doffing PPE. Now, this entirely depends on what type of isolation your patient is in, so make sure you know specifically what PPE to use. In this video, we’re going to assume our patient is in Droplet and Contact precautions and that there might be some splatter. So we’ll use a gown, gloves, goggles, and a mask.

For starters, remember that PPE should always be donned and doffed in a doorway or ante room. And you always start by performing hand hygiene.
The first thing you’re going to apply is your gown. Usually you have these plastic gowns in little plastic packages, so remove the gown, and open it up to find the sleeves. Put your arms in the sleeves, making sure your thumbs go in the thumb holes, then put your head through the head hole or tie the gown around your neck. Then tie the ties around your waist.
Next is your mask. For a standard surgical mask, you want the ties to be in the middle of the back of your head and at the base of your neck. If you have masks with ear loops, then simply loop them over your ears. Pinch the nose piece over the bridge of your nose and pull the bottom of the mask over your chin.
Next you’re going to apply your goggles. Remembering the order here is pretty easy, if your goggles were already on, you wouldn’t be able to get your mask on. So mask first, then goggles.
Finally you can apply your gloves. Just make sure that you pull the cuff of the gloves over the wrist of the gown so you’re fully protected.
Now, you’re ready to enter the patient’s room. Once you’re done in the patient’s room, you have to take all of the PPE off without cross-contaminating anything. So what you NEED to know now is what parts of the PPE are considered contaminated and what parts are clean?
First, the entire outside of the gloves are dirty, as well as the whole front of your gown, mask, and goggles. What IS still clean is the ties on the back of the gown and mask, the inside of the gown and gloves, and the earpieces of your goggles. So when you DOFF your PPE, you have to think about all of these things. We’re going to show you two ways. The first is the way the CDC has approved and teaches.
The very first thing you’re going to remove is your gloves – they are the most contaminated. Grasp the wrist of one glove and pull it off inside out, then ball it up in your other gloved hand.
Then, carefully slip a finger under the cuff of the other glove without touching the gown, if possible, and pull it off inside out over the other glove. Then throw them in the trash.
So now you have somewhat clean hands – you can take off your goggles by the earpieces, remember don’t touch the front!
Now you’ll remove your gown. Carefully reach back and untie the waist ties – touch ONLY the ties.
Now reach up and untie the neck ties, then you can pull the gown forward – still only touching the ties or the inside of the gown. You’ll peel the gown down and turn it inside out as you do. You may need to let your hands come inside the sleeves a bit so they don’t touch the outside. Then ball it up and throw it in the trash.
Now, you can remove your mask using JUST the ties or ear loops and throw it away. Remember, though – if your patient is in airborne precautions, you do not remove your mask until you are OUT of the room with the door closed behind you! Then, of course, perform hand hygiene.
Now, this is the CDC approved method, but you can see how there’s still a high risk of contamination. We want to show you another method that is NOT what the CDC recommends, but it is what most of us use in the real world.
So, same PPE – gown, mask, goggles, gloves. Now, this method only works with plastic gowns that break easily. If you have cloth gowns that tie, you have to use the other method. So, instead of removing your gloves first, you’re going to grab the front of the gown and pull forward. This should break the ties at the neck and around the waist.
Then you’ll begin to turn the gown inside out and ball it up. So the inside of the gown is what’s exposed – which is clean! Now you’ll carefully pull off the gown and glove inside out off of one hand and keep it balled up. Then you can reach your fingers under the glove on the other side and pull it off inside out as well.
Then, since it’s just the inside of everything that is exposed, you can ball it up and throw it in the trash.
NOW you can remove your goggles- still using the earpieces only. Then your mask by the ties or ear loops and throw them away. Then, perform hand hygiene and you’re done.

Not only is this more practical, but it is faster. Just make sure you aren’t mindlessly ripping PPE off – you still need to pay attention to what is and isn’t contaminated and protect yourself and your other patients!
We hope this was helpful. One of my favorite ways to practice this is to get a plastic gown and put shaving cream on the outside of my gloves and gown. If you can get it off without getting shaving cream on your skin, you know you did it right!

Alright guys, go out and be your best selves today! Happy nursing!