The greatest risk with PPE is not the moment of exposure — it is the moment of removal. Doffing PPE incorrectly is one of the most common causes of self-contamination. The sequence exists to protect you.
Section 01
The Core Principle
💡 Outside is dirty, inside is clean
The outside surface of PPE is contaminated during use. The inside is relatively clean. Every removal step must prevent the contaminated outside from touching your skin, face, or clean clothing. This principle guides every step of doffing.
Section 02
Donning Sequence
Hand hygiene
Always first. Clean hands before any PPE is donned.
Gown
Tie at neck and waist. Inside remains clean.
Mask or respirator
Apply and secure. N95: perform seal check. Mask goes on before eye protection.
Eye protection
Position goggles or face shield over the mask.
Gloves
Don last. Gloves should cover gown cuffs. Now ready for patient care.
Section 03
Doffing Sequence — The Critical Part
🚨 Doffing order: gloves → hand hygiene → eye protection → gown → mask → hand hygiene
1. Gloves first — most contaminated. Pinch outside of one glove, pull inside-out. Hook bare finger under second glove, pull inside-out. Contaminated surfaces end up inside the bundle.
2. Hand hygiene — immediately after gloves, before touching anything else.
3. Eye protection — remove by earpieces or headband, never touch the front surface.
4. Gown — untie at back touching only the ties. Roll inward — dirty outside rolls to the inside. Discard without touching outer surface.
5. Mask — remove last using ear loops or ties only. Never touch the front.
6. Hand hygiene — always last.
2. Hand hygiene — immediately after gloves, before touching anything else.
3. Eye protection — remove by earpieces or headband, never touch the front surface.
4. Gown — untie at back touching only the ties. Roll inward — dirty outside rolls to the inside. Discard without touching outer surface.
5. Mask — remove last using ear loops or ties only. Never touch the front.
6. Hand hygiene — always last.
Section 04
Most Common Doffing Errors
Error
- Touching front of mask when removing
- Removing gloves last (after mask)
- Skipping hand hygiene between steps
- Touching eyes when removing eyewear
- Snapping or shaking gloves during removal
Why it matters
- Front of mask is most contaminated
- Gloves contaminate the mask during removal
- Each removal creates contamination risk
- Eyes are a direct pathogen entry route
- Snapping aerosolizes organisms
Section 05
PPE Disposal in the Home
✓ Safe disposal at home
Place used PPE in a plastic bag before household trash disposal. Never leave used PPE accessible in client's home. Gowns and masks from contact-precaution rooms must be disposed of within the room — not carried through the home. Contact agency for specific disposal guidance for contact-precaution clients.
Knowledge Check
Lesson 4 Quiz
Question 1
The primary reason gloves are removed first in the doffing sequence is:
Question 2
When removing a used surgical mask you should touch only:
Question 3
Hand hygiene must occur during the doffing sequence:
Question 4
When removing a gown after contact-precaution care you should:
Question 5
Snapping or shaking gloves during removal is a significant error because: