Donning and doffing PPE correctly is essential to prevent contamination and ensure safety.
Personal protective equipment (PPE) is the first line of defense in infection control, helping stop the spread of bacteria and viruses. Following the proper donning and doffing sequence is a critical safety practice that protects healthcare workers and reduces the risk of cross-contamination.
To stay compliant with OSHA and CDC guidelines, every healthcare professional should understand the correct PPE sequence and apply it consistently in real-world settings.
So, what Is the Correct Order for Putting on PPE?
Quick Answer:
The correct order for putting on PPE is:
1. Gown
2. Mask or respirator
3. Goggles or face shield
4. Gloves
This sequence helps reduce contamination risk and ensures proper protection for healthcare workers.
Critical Note: Hand hygiene must be performed between steps if hands become contaminated, especially after removing gloves.
In this guide, you’ll learn:
Table of Contents
- OSHA Standards for PPE Donning and Doffing Training
- The CDC-Compliant PPE Donning Order: Step-by-Step
- Beyond the Basics: Integrating Shoe Covers and Hair Nets into the PPE Order
- Donning vs. Doffing PPE: Key Differences & Comparison Table
- Safe Doffing PPE Procedure: Avoiding Self-Contamination
- Common Mistakes in the PPE Donning and Doffing Sequence
- Frequently Asked Questions About PPE Protocols
- Knowledge Check: Are You PPE Ready?
- Conclusion
OSHA Standards for PPE Donning and Doffing Training
Maintaining a safe workplace is a legal requirement. According to OSHA standards, employers must ensure all staff receive comprehensive training on the use of standard ppe. Furthermore, for facilities handling hazardous drugs, adhering to USP 800 guidelines regarding gown and glove thickness is essential for worker protection. Establishing a clear donning ppe order as part of the annual safety curriculum is the most effective way to ensure regulatory compliance.
The CDC-Compliant PPE Donning Order: Step-by-Step
Following this specific ppe donning sequence ensures that your most vulnerable areas—the respiratory system and mucous membranes—are protected before you seal the barrier with gloves.
Before Putting on PPE: Inspection & Hand Hygiene
Before beginning the donning ppe order, you must ensure your ppe gear is ready for use. Selecting proper protective equipment starts with a critical inspection phase to ensure no breaches in safety occur:
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Check for Integrity: Carefully examine medical gowns and gloves for tears or manufacturing defects. Ensure respirator masks and surgical masks have functional, elastic straps and an intact nose bridge.
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Personal Preparation: Remove all jewelry, such as rings and watches, which can tear disposable nitrile gloves or harbor pathogens. Secure long hair away from the face to ensure a perfect seal for facial protection.
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Initial Hygiene: Perform thorough hand hygiene using an alcohol-based hand rub or soap and water. This is the foundation of the entire donning and doffing process.
Step 1: Gowning – Securing the Torso and Arms
The gown fully covers the torso from the neck to the knees, with long sleeves extending to the wrists. It wraps around the back and is secured at the neck and waist. Gowning PPE correctly requires full coverage.
- Put on the gown with the opening in the back.
- Ensure the material fully covers your torso from neck to knees and your arms to the end of your wrists.
- Critical Detail: Fasten the ties at the back of the neck and the waist. Do not leave the waist tie loose, as a billowing gown increases the risk of snagging and contamination.
- If the gown is too small to wrap around your back fully, use two gowns (the first worn with the opening in the front, the second over it with the opening in the back).
- Hygiene Check: Ensure you do not touch the floor or other surfaces while securing the gown ties. If you do, perform hand hygiene again.
Tip : Not all gowns are created equal. The level of fluid resistance depends entirely on the layering technology. To understand why we use a triple-layer structure for our PPE, check out our technical breakdown: [The Science of Protection: SMS vs. SMMS Nonwoven Fabric Technology].
Step 2: Placing the Respirator Masks or Face Mask
Ensure proper fit by securing the ties or elastic bands at the middle of the head and neck. Adjust the flexible nose bridge to conform comfortably to the nose. The respirator should fit snugly against the face, covering the nose and mouth, and extend below the chin. After positioning, perform a fit check to confirm an effective seal and proper fit.
- Secure the ties or elastic bands at the middle of your head and neck.
- Fit the flexible band to the bridge of your nose.
- Fit the mask snugly to your face and below your chin.
- Fit Check: If wearing an N95 respirator, you must perform a user seal check every time you put it on to ensure no air leaks around the edges.
- Hygiene Check: Once the mask is fitted, do not touch it again. If you need to readjust, sanitize your hands first.
Pro Detail: If using an N95 respirator, it must be donned BEFORE entering the patient room and removed only AFTER leaving the room and closing the door to avoid inhaling airborne pathogens.
Step 3: Eye Protection (Face Shield and Goggles)
Position the goggles or face shield securely over your face and eyes, then adjust for a comfortable and proper fit.
- Place goggles or face shield over your face and eyes and adjust to fit.
- Personal prescription glasses are not considered adequate eye protection. The goggles or shield must sit securely over the mask, ensuring no gaps where splashes could enter.
- Hygiene Check: Avoid touching the front of the mask while placing the goggles.
Step 4: Gloving – Covering the Cuffs
Ensure that gloves extend fully to cover the wrist of the isolation gown, providing a secure and continuous barrier to maintain proper infection control.
- Extend your hands into the gloves.
- Crucial Safety Detail: Pull the cuffs of the gloves over the cuffs of the gown.
- There should be no exposed skin between the glove and the gown sleeve. This “shingling” effect ensures that fluids roll off the gown and onto the glove, rather than seeping onto your wrist.
- Hygiene Check: You are now fully protected. Do not touch your face or personal items (like phones) once gloves are on.
Following this specific sequence is scientifically designed to ensure that your most vulnerable areas (respiratory system and mucous membranes) are protected before you seal the barrier with gloves.
Memory Aid for Donning: Think “Bottom Up”. You start with the body (Gown), move up to the face (Mask/Goggles), and finish with the hands (Gloves) raised.
Selecting the right material for this final barrier is crucial. Read our guide on Nitrile vs Latex vs Vinyl Gloves to understand which material offers the best chemical and viral resistance for your specific procedure.
Beyond the Basics: Integrating Shoe Covers and Hair Nets into the PPE Order
While the four-step sequence is standard, certain environments—such as surgical suites, laboratories, or veterinary clinics—may require additional layers. When your task involves a more complex ppe order, follow these integration rules:
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Hair Nets/Caps: These should be put on before the isolation gowns to ensure no hair falls onto the sterile exterior of the gown.
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Shoe Covers: Put these on first, or immediately after the gown, to ensure your hands are still clean before moving to facial protection.
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Lab Coats: In lower-risk settings where isolation gowns aren’t required, the same donning and doffing principles apply—always protect the face before finishing with gloves.
Ensuring the proper ppe is used for the specific hazard level is key to breaking the chain of infection across diverse industries.
Donning vs. Doffing PPE: Key Differences & Comparison Table
Before moving on to the removal process, it’s important to understand how donning and doffing sequences differ:
| Process | Correct Order | Key Principle |
|---|---|---|
| Donning (Putting On) | Gown → Mask/Respirator → Goggles/Face Shield → Gloves | Protect yourself from exposure |
| Doffing (Removing) | Gloves → Goggles/Face Shield → Gown → Mask/Respirator | Avoid self-contamination |
Safe Doffing PPE Procedure: Avoiding Self-Contamination
The process of removing ppe equipment poses a higher risk for self-contamination because the gear is now considered “dirty.” The golden rule of the doffing ppe procedure is to assume the outside of all equipment is contaminated.
Memory Aid for Doffing: Think “Alphabetical Order”. Remove in this sequence: Gloves, Goggles, Gown, Mask. (Note: Some protocols combine gloves and gown removal, but the principle remains: protect the face until the end).
Critical Doffing Checkpoints (Don’t Do This):
- ❌ Never remove the mask before the gloves (this exposes your face to dirty hands).
- ❌ Never touch the front of the gown with bare hands.
- ❌ Never reuse disposable PPE once removed.
Step 1: Advanced Technique – Removing Isolation Gowns and Medical Gloves Simultaneously
The most critical moment in donning and doffing is the transition from “dirty” to “clean.” To minimize self-contamination, many advanced clinical protocols recommend removing the gown and medical gloves in one synchronized motion:
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Break and Reach: Reach up to the shoulders and carefully break or unfasten the neck ties, ensuring the contaminated front of the gown does not touch your scrubs.
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The “Balling” Technique: Grasp the gown at the chest and pull it away from your body. As you slide your arms out of the sleeves, peel off your medical gloves at the same time, turning them inside out.
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Roll into a Bundle: Continue to fold or roll the gown into a bundle (dirty side inward) as you move down to the waist. This “rolls” all pathogens into a contained ball, which can then be safely discarded.
This specific technique ensures that your bare hands only touch the inside of the equipment, significantly reducing the risk of a breach in your donning ppe order safety cycle.
Step 2: Hand Hygiene (First Round)
Perform hand hygiene immediately after removing gloves and gown. This is a critical checkpoint. If your hands were contaminated during the removal of the dirty gloves/gown, you do not want to touch your face to remove your mask. Do not skip this step.
Step 3: Removing Eye Protection and Mask
- Eye Protection: Remove goggles or face shield from the back by lifting head band or ear pieces. The front of the face shield is contaminated—do not touch it.
- Mask/Respirator: Grasp the bottom ties or elastics first, then the top ones. Remove without touching the front of the mask. Discard.
- Hygiene Check: With clean hands, remove these items carefully. If you accidentally touch the front of the shield or mask, stop and sanitize your hands immediately.
Step 4: Final Hand Hygiene
Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer immediately after removing all PPE. This ensures no residual pathogens remain before you leave the procedure area.
Common Mistakes in the PPE Donning and Doffing Sequence
| DO ✅ | DON’T ❌ |
|---|---|
| Do perform hand hygiene immediately after removing gloves. | Don’t touch the front of your mask or goggles. |
| Do ensure the gown covers your back completely. | Don’t leave the waist ties loose. |
| Do use a buddy system to check fit. | Don’t rush the doffing process. |
Frequent errors include failing to pull gloves over gown cuffs during gowning PPE, touching the front of the mask during doffing PPE, or rushing the removal process. These lapses break the sterile field and significantly increase the infection risk for the healthcare worker.
- The “Wrist Gap”: Failing to pull gloves over the gown cuffs leaves wrists exposed to fluids and pathogens.
- Touching the “Dirty” Zone: Adjusting the front of the mask or goggles while in a patient room contaminates the hands.
- Improper Doffing Order: Removing the mask before the gloves puts your face at immediate risk of contact with contaminated hands.
- Re-wearing Single-Use Items: Disposable gowns and gloves are designed for one-time use; material degradation compromises safety if reused.
Knowledge Check: Are You PPE Ready?
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Scenario: Your task requires a gown, mask, goggles, and gloves. Which one goes on FIRST?
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Check: Did you remember to perform hand hygiene after removing gloves but before removing your mask?
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Challenge yourself: If you missed any steps, review our Common Mistakes in Gowning and Doffing section above to ensure 100% safety.
Frequently Asked Questions About PPE Protocols
Q: Is the order for putting on PPE different for sterile surgical procedures?
A: Yes. While the standard ppe order focuses on protecting the worker, surgical protocols focus on maintaining a sterile field for the patient. Always consult your facility’s specific hospital ppe protocol.
Q: What is the most critical step in doffing PPE?
A: The most critical aspect of doffing PPE is Hand Hygiene. It must be performed immediately after removing gloves (the most contaminated item) and again after removing the mask. If at any point during the removal process you suspect your hands have touched a contaminated surface, you must stop and sanitize your hands before proceeding to the next piece of equipment.
Q: Why must the N95 respirator be removed last?
A: This is a critical part of the ppe sequence. Because the N95 protects against airborne pathogens, it must remain on until you have exited the contaminated area and closed the door to prevent inhalation of infectious aerosols.
Q: What should I do if my PPE tears or gets heavily soiled during a procedure?
A: If a glove tears or a gown becomes heavily soiled/compromised, you must stop working immediately. Withdraw from the sterile field or patient area, perform the doffing procedure safely, perform hand hygiene, and don new PPE before resuming care.
Q: Why is the N95 respirator put on before entering the patient room, while other gear might not be?
A: This is a critical part of the donning ppe order. Unlike standard surgical masks, an N95 respirator provides airborne protection. It must be donned and fit-checked before potential exposure to ensure a 100% seal. Following the proper ppe sequence ensures that your respiratory system is fully protected before you encounter any infectious aerosols.
Conclusion: Safety is a Sequence, Not Just a Product
Protecting healthcare workers goes beyond simply purchasing the right medical gowns or nitrile gloves. It requires a disciplined commitment to the correct order for putting on PPE and, even more critically, the safe procedure for removing it.
Whether you are managing a hospital’s PPE order or are a student learning gowning PPE for the first time, remember this: Contamination happens in the margins. It happens when a wrist is exposed, when a mask is touched, or when steps are rushed.
By following this step-by-step guide and adhering to strict hand hygiene protocols, you ensure that the barrier remains unbroken—protecting not just yourself, but every patient under your care.
References & Further Reading
- Centers for Disease Control and Prevention (CDC). Sequence for Personal Protective Equipment (PPE) Donning and Doffing. https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdf
- U.S. Food and Drug Administration (FDA). Medical Gowns and Protective Apparel Regulation. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/medical-gowns
- Occupational Safety and Health Administration (OSHA). Personal Protective Equipment Standards for Healthcare. https://www.osha.gov/personal-protective-equipment
- National Institute for Occupational Safety and Health (NIOSH). Understanding the Difference: Surgical Masks vs. N95 Respirators. https://www.cdc.gov/niosh/npptl/pdfs/understanddifferenceinfographic-508.pdf
- ASTM International. ASTM F2100 – Standard Specification for Performance of Materials Used in Medical Face Masks. https://www.astm.org/f2100-23.html
Disclaimer: This guide is based on CDC and OSHA standards as of 2026. Protocols may vary by facility and specific infectious disease risks. Always consult your facility’s Infection Control Department for local guidelines.
