DONNING of Personal Protective Equipment (PPE)

1. Ensure that a trained Observer is available to verify compliance with all steps.
2. Ensure that all the needed supplies are available.
a. Items needed
i. Impermeable shoe covers
ii. N95 respirator
iii. Goggles
iv. Impermeable coverall
v. Plastic apron
vi. Three sets gloves with extended cuffs
vii. Freshly-prepared 1:10 bleach solution
viii. Alcohol-based hand rub
3. Prepare for donning of PPE.
a. Wear scrubs
b. Wear plastic or rubber boots
c. Remove watch, jewelry, and contents of the pockets
d. Secure hair
4. Inspect PPE items prior to putting them on.
a. Ensure that all items are in good working condition
b. Make sure that the sizes are correct
5. Put on boot covers
6. Perform hand hygiene
a. Use alcohol-based hand rub
b. Allow hands to dry before moving to the next step
7. Put on inner gloves
8. Put on cover-all/gown
a. Make sure that cover-all is large enough for free movement
b. Make sure that the cuffs of inner gloves are tucked undersleeves of the cover all
c. Zip up cover-all
9. Make thumbholes at the border of cuff and sleeves
a. Use a scissor to make a small incision
10. Put on N95 respirator
a. Cup the respirator in your hand with the nosepiece at the fingertips
b. Position the respirator under your chin with the nosepiece up
c. Pull the top strap over your head resting it high at the back of your head
d. Pull the bottom strap over your head and position it around the neck, below the ears
e. Mold the nosepiece using two fingers of each hand to the shape of your nose
f. Pinching the nosepiece using one hand may compromise the respirator performance
11. Perform seal check
a. Inhale deeply and feel the respirator slightly being sucked in
b. Exhale sharply and feel the respirator slightly bulge
12. Put on hood
a. Make sure that the hood covers all of hair, ears, and neck with no skin exposed
13. Put on outer apron
a. Tie the apron with a simple knot for easier removal
14. Put on outer gloves
a. Ensure the cuffs are pulled over the sleeves of the gown/cover-all
15. Put on face shield or goggles
16. Let the trained observer check the worn PPE
a. Make sure that all parts of the skin are covered
b. All areas of the body should be covered during the range of movement
c. The healthcare worker should be able to extend his/her arms, bend at the waist, and do
range of motions
Key points in Doffing PPE

1. PPE should be taken off in a designated PPE removal area

2. Put all PPE in a leak-proof bag for infectious waste
3. Doff PPE only with supervision of a trained observer

Recommended PPE for Trained Observer

1. Single-use full face shield and disposable face mask

2. Cover, or a single-use fluid-resistant gown that extends below the knees
3. Single-use, double gloves with extended cuffs (at minimum, outer gloves should have extended
cuffs)
4. Single-use fluid-resistant boots or impermeable shoe covers

DOFFING of Personal Protective Equipment (PPE)

1. Inspect PPE for visible contamination or tears

a. In case of visible contamination, use 1:10 bleach disinfectant to wipe it off
2. Disinfect outer gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
3. Remove apron
a. Break the apron by pulling from the neck
b. Avoid contaminating gloves by rolling the apron from inside-out
4. Inspect the PPE again
a. Assess the PPE for visible contamination or tears
b. If with visible contamination, disinfect with 1:10 bleach disinfectant
5. Disinfect outer gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
6. Remove boot covers
a. Use a hands-free approach by stepping on the back of the cover and lifting the foot
b. Touch only the inner surface of the boot cover
7. Disinfect outer gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
8. Remove outer gloves
a. Be careful not to contaminate the inner gloves when removing the outer gloves
9. Inspect and disinfect the inner gloves
a. In case of contamination or tears, disinfect and remove gloves and do hand hygiene on
bare hands and put on a new pair of gloves
b. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
10. Remove goggles
a. Lift back of the strap over your head, pull out and away
b. Avoid touching the front surface of the goggles
11. Disinfect inner gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
12. Remove the hood
a. Unfasten hood (if applicable). Grasp the back of the hood and carefully remove by pulling
backwards
b. Do not touch the inside of the hood
13. Disinfect inner gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
14. Remove coverall
a. Avoid contact of scrubs with outer surface of coverall
b. Lift chin
c. Find the zip at the level of your belly
d. Carefully trace your fingers up to find the zip tab and fasteners with one hand
e. Hold the top of the coverall with the other hand
f. Unzip or unfasten completely before rolling down and turning inside-out
g. Avoid contact of scrubs with the outer surface of the coverall. Touch only the inside of
the coverall.
h. Touch only the inside of the coverall when rolling it prior to disposal
15. Disinfect inner gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
16. Change inner gloves
a. Remove and discard gloves, taking care not to contaminate bare hands
b. Perform hand hygiene with alcohol-based hand rub
 c. Put on a new pair of gloves
17. Remove the N95 respirator
a. Tilt the head slightly forward
b. Grab the bottom tie or elastic strap
c. Then grab the top tie or elastic strap
d. Remove without touching the front of the N95 respirator
e. Discard the N95
18. Disinfect gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
19. Disinfect washable boots
a. Sit on a clean surface
b. Starting at the top and finishing with the sole, wipe down the external surface of the first
boot. Use a 1:10 bleach disinfectant
c. Set down the newly-cleaned boot in the low-risk zone
20. Disinfect and remove gloves
a. Use a 1:10 bleach disinfectant or an alcohol-based hand rub
21. Perform hand hygiene
a. Use alcohol-based hand rub
22. Inspect for any contamination

Reminders after removal of PPE

1. The healthcare worker can wear the dedicated washable boots and surgical scrubs in the low-risk
area
2. Healthcare workers entering high-risk areas should shower or at least change clothes when
leaving the low-risk area
3. Clean the floor of the PPE removal area with disposable cloth soaked in 1:10 bleach solution after
PPE removal is complete

For breaches in PPE

1. Wash skin with soap and water

2. Irrigate mucous membranes with copious amounts of water or an eyewash solution
3. Report the incident immediately