IPCWell - Infection Control Consultant & Expert - United States

Wearing PPE is only effective if worn, donned, and doffed correctly. I want to share a few quick notes on PPE so that we can keep our healthcare workers and residents as safe and healthy as possible. To demonstrate how easy cross contamination can occur, I use paints to represent germs, and have healthcare workers put on and remove PPE. The paint shows us what went wrong, and how the efficacy is nullified if we do this incorrectly. Incorrectly using PPE is also one of the top CMS state and federal F880 citations.

The pandemic we are in has given us new challenges, and going against all our past infection control practices, we have had to reuse PPE and be creative with supply to simply keep our heads above water.

Let’s have a quick refresher for the sequence of donning and doffing.

  1. The first step is always hand hygiene. (The second step is asking yourself, “Did I remember to perform hand hygiene?”)
  2. Next, since we are already wearing face masks and eye protection for source control, we want to don the gown.
  3. Be sure to completely tie up your gown, as I have unfortunately seen citations for incomplete gown tying. You do not want to get cited for anything, much less part of your gown being untied! The time spent making sure your gown is tied correctly is worth the safety of all those in your facility, and to not receive a citation.
  4. Don your gloves. They should cover the outside of the gown. Tuck the gown sleeve into the glove.

Leaving the resident room is when we need to be extra vigilant with our doffing, as contamination may have occurred.


  1. Remove your first glove by pinching the palm of the glove with your other hand and pulling it off. Take two fingers of your ungloved hand and go under your other glove at the wrist. Both should be pulled off so that the glove ends up inside out to avoid contamination. Gloves should be discarded in the trash inside the room where they were used.
  2. Gowns are next, and usually the pull off and roll procedure is used, but because of supply issues, many facilities are reusing gowns using the CDC’s optimization protocol. If possible, perform hand hygiene between doffing the gloves and gown. When doffing the gown with intent for reuse, put two fingers inside one sleeve at the wrist, and then with your hand in the sleeve, remove the other sleeve. Pull the gown off away from your body and hang it with the front of the gown facing the wall on a hook in the room. This way, when you go back to reuse it, you need to  simply put your arms back into it to put it back on.
  3. Face shield is next, and before touching it perform hand hygiene. Remove and properly clean, disinfect, ad store your face shield.
  4. Remove and throw away your mask.

Be sure you keep PPE in easily accessible areas. For example, if you have a resident on a 14-day quarantine, make sure the bins are directly outside of the room.

Paying attention to donning and doffing PPE can literally save lives! Let’s follow the proper procedures and erase any harms caused by cross contamination. Thank you to all our healthcare worker superheroes out there. Be safe and be well.