Guidance for Use of PPE in Healthcare Settings

Overview

Personal protective equipment only works when it is put on and taken off correctly. In healthcare settings, the moments of highest risk are often the transitions: gowns that gap at the wrists, respirators that fail their seal check, contaminated glove surfaces touching skin during removal, or doffing areas that blur into clean zones. This checklist is designed to support healthcare personnel in safely applying and removing PPE in clinical environments. It identifies the supplies you need, defines who does what, sets out how the space should be arranged, and then walks step by step through donning and doffing. It is intended as a shared reference at the point of care, so that the sequence is the same for everyone each time.

What a good PPE process covers

A workable PPE process is more than a list of equipment. It holds together four things. **Supplies that are ready and complete.** The checklist names the items that need to be available and within easy reach, including alcohol-based hand sanitizer with at least 60% alcohol, EPA-registered hospital-grade disinfectant wipes, nitrile gloves with extended cuffs in two visually distinct colors for inner and outer layers, impermeable gowns or coveralls, NIOSH-certified fit-tested N95 respirators, impermeable surgical hoods, full face shields, impermeable aprons, and impermeable boot covers extending to mid-calf. Several of those garments are described as meeting ANSI/AAMI PB70 Level 4 requirements, with the gown or coveralls also described as meeting ASTM F1671 at 13.8 kPa. **Clear roles.** The checklist separates the people involved: the Caregiver, the Trained Observer, and the Doffing Assistant. Each has defined limits. **A one-way layout.** Donning and doffing areas are labeled and physically separated, and the flow is unidirectional from clean to contaminated, with no backtracking. **A sequence that survives contact.** The steps pair each removal with decontamination and disposal, so contamination is managed while it happens rather than afterward.

Why the details matter

Small gaps in technique create exposure paths. A respirator worn without a seal check may leak; gloves pulled off by the outer surface can carry contamination to bare skin; a gown shrugged off instead of rolled inward can spread what it caught. The checklist reflects this by building decontamination into the doffing sequence, repeating it between removals, and ending with a final integrity inspection and end-of-shift hygiene practices. The Trained Observer role exists for the same reason. This person monitors all donning and doffing procedures and verifies PPE integrity, but must not provide physical assistance. The Doffing Assistant, who may give hands-on help during doffing, must not also serve as the Observer. Keeping those functions apart means the verification step stays independent of the handling step.

How to carry out the process

1. **Check the space and the supplies first.** Confirm signage separates the donning and doffing areas, that the donning area is kept as a clean zone stocked with all required PPE and its designated chair, and that the doffing area has hand sanitizer, disinfectant wipes, two chairs, and designated medical waste containers. 2. **Confirm roles for the shift.** Name the Caregiver, the Trained Observer, and, if hands-on doffing assistance is expected, the Doffing Assistant. 3. **Don PPE in order.** Remove personal items and tie back hair; change into scrubs and dedicated footwear; perform hand hygiene; then work through boot covers, inner gloves, gown or coveralls, N95 respirator with a user seal check, surgical hood, outer apron if required, outer gloves over the gown sleeves, and the full face shield. 4. **Take the visual inspection seriously.** Before entering the patient care area, the Trained Observer confirms no exposed skin, checks range of motion for proper fit, and verifies all seals are intact. 5. **Doff in sequence.** Inspect for visible contamination, decontaminate gloves, and remove the apron, outer gloves, face shield, surgical hood, gown, and boot covers in turn, decontaminating gloves between each removal and disposing of each item in designated medical waste. 6. **Finish clean.** Remove the inner gloves, perform hand hygiene until completely dry, don a fresh pair of clean nitrile gloves, remove the N95 respirator by lifting the lower strap over the head first and then the upper strap, decontaminate gloves, wipe down dedicated footwear with EPA-registered disinfectant wipes, and decontaminate gloves once more.

Frequently Asked Questions

It's a three-part arrangement that keeps a donning and doffing sequence accountable. The Caregiver provides direct patient care and wears surgical scrubs or disposable garments with dedicated washable footwear. The Trained Observer watches every donning and doffing procedure and verifies PPE integrity, but must not give physical assistance. The Doffing Assistant, or Buddy, provides hands-on help during doffing and must not also serve as the Observer; if the Assistant enters the patient care area, they wear full PPE equivalent to the Caregiver's.

The checklist calls for clearly labeled, physically separated donning and doffing areas with signage, and a unidirectional workflow: donning area, then patient room, then doffing area, with no backtracking. The donning area is kept as a clean zone stocked with all required PPE and a designated chair. The doffing area holds hand sanitizer, disinfectant wipes, two chairs, and designated medical waste disposal containers.

The sequence covers removing personal items, tying back hair, securing eyeglasses, changing into scrubs and dedicated footwear, hand hygiene, boot covers, inner gloves, gown or coveralls, N95 respirator with a user seal check, surgical hood, outer apron when needed, outer gloves over the gown sleeves, and a full face shield. A Trained Observer then performs a visual inspection before you enter the patient care area.

The doffing steps pair each removal with decontamination and disposal: decontaminate gloves, remove the apron, outer gloves, face shield, surgical hood, gown, and boot covers in sequence, decontaminating gloves between each step and disposing of items in designated medical waste. You then remove the inner gloves, perform hand hygiene, don fresh nitrile gloves, and remove the N95 respirator by lifting the lower strap over the head first and then the upper strap, avoiding the front of the respirator.

The checklist asks the Trained Observer to inspect PPE for visible contamination, rips, or tears before doffing begins; if contamination is found, wipe the affected area with EPA-registered disinfectant wipes before proceeding. This inspection is repeated at points during doffing, and you also wipe down dedicated footwear with EPA-registered disinfectant wipes near the end of the sequence.

Written by

Arne Reis

Founder

Process optimizer with 25 years of expertise, focused on operational excellence in quality, maintenance, EHS, and commissioning. Emphasizes innovative solutions and top-quality standards.

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