Clinical Skills - Donning and Doffing PPE
by Ellis Parker January 28, 2022 Updated: December 07, 2022 4 min read
This article demonstrates how to don and doff PPE (personal protective equipment) as part of ensuring infection control when tending to patients.
The Clinical Skills video series follows along with our Clinical Nursing Skills Flashcards, which provide step-by-step instructions and best practices for most skills used by practicing nurses and for the skills tested by most nursing schools during the laboratory portion of fundamentals.
When you see this Cool Chicken, that indicates one of Cathy's silly mnemonics to help you remember. The Cool Chicken hints in these articles are just a taste of what's available across our Level Up RN Flashcards for nursing students!
Donning means to put on. PPE is required when dealing with certain patient situations, for example, when a patient is on isolation precautions.
GMEG = “Gee Meg, my patient is on isolation precautions!”
PPE is always donned in the same order. Some situations do not require certain parts of it, depending on what type of precaution the patient is on. The following is a demonstration of the full order of donning PPE.
1. Perform hand hygiene
Before applying PPE (personal protective equipment) it is important to have already done hand hygiene. This was covered in the previous video in this series.
2. Secure the gown
Starting with the gown, slip the arms in first, find the ties, and tie to secure. Tie the ties in a bow.
For the front ties, tie these around the waist.
3. Don the mask
When putting on a mask, the blue side goes out (if using a medical mask). If there is a metal piece in the nose, bend it so the mask sits snugly on the bridge of the nose. Make sure that the mask is always pulled down to cover the chin.
4. Don eye protection
Next, don eye protection. Note that glasses do not count as eye protection. Additional protection must be worn on top of glasses.
5. Don the gloves
The final step is to don gloves. The gloves need to be pulled down so they go over the cuff of the gown. This way there is no point where any of the hand or wrist or forearm is exposed to anything.
Remember: All of these steps should be taken before entering the patient’s room. If the patient is on any type of precautions, it is important to be safe before entering their space.
Doffing means to take off. Remove PPE in the reverse order it was donned.
1. Remove the gloves
Start by taking off the gloves. It is important to remember that these are dirty. You have touched something that is contaminated or been in the room of a patient who is on precautions. That means the gloves are dirty, so care must be taken when removing them.
Pull the first glove off by taking hold of the lower cuff. Do not put fingers of the gloved hand on the inside of the glove to be removed. Slip the first glove off, and roll it up in the palm of the still-gloved hand. Then, with the free hand, slip a finger under the glove and roll that one off. You should have one balled-up glove, with the first glove inside it. Dispose of these.
2. Remove eye protection
To remove eyewear, make sure to touch this piece of equipment as far back as possible. The front is contaminated, having been exposed directly to the patient, so remove eyewear from the back. Once eyewear is removed, either discard it or, as is practiced in many facilities, set the eyewear aside so it can be cleaned and reused.
3. Remove the gown
To remove the gown, untie it first (in practice, often it is easier to simply break the ties).
Remove the arms from the gown by holding the gown by the cuff on the wrist and rolling it down as you slip your arms out. Note that the farthest part of the cuff was protected by the glove cuff, so that’s the safest place to touch the gown.
Once the gown is removed, touch it by the inside (the side that was against you). Then dispose of the gown.
4. Remove the mask
The next step is to remove the mask. As with eye protection, pull the mask off from the back ear loops, not from the front. Pull it straight away from the face, then dispose of the mask.
The reason the mask is doffed last is because PPE has to be removed inside the patient’s room. You can’t leave the patient’s room with any PPE on, or any contaminants that may be in the patient's room will be brought out into the general population. Then, last, remove the mask on the way out the door. That way you are not inhaling anything in the patient’s room that might be infectious.
5. Practice hand hygiene
Always complete the doffing of PPE — after having left the patient's room — with another good hand washing.
Remember: When doffing PPE, avoid touching the outside of the PPE elements, as they have been contaminated.
Hi, I'm Ellis with Level Up RN and in this video I'm going to be demonstrating how to dawn and doff PPE. And that just means how to put on and take off my personal protective equipment. I'll be following the steps that we've included in our Clinical Nursing Skills deck. So if you have the deck, go ahead and grab it and you can follow along with me. If you don't have the deck and you're interested in checking it out, head on over to LevelUpRN.com.
Before I can apply PPE or personal protective equipment, I need to have already done hand hygiene so I've done that. PPPE always goes on in the same order. You may or may not use certain parts of it depending on what type of precaution your patient is on. But I'm going to demonstrate the full order in case we were using all parts today.
So we start with the gown. So I'm going to go ahead and slip my arms in, find my ties, and this, of course, should be done before you enter your patient's room. If my patient's on any type of precautions I need to be safe before I enter their space. I'm going to tie it in a bow and then there's front ties as well to tie it around your waist. All right. Next is my mask. So I'm going to go ahead and put my mask on. The blue side goes out if we're using these medical masks and there's a metal piece in the nose to bend it over. I always want to make sure I pull it down to cover my chin. Next I'm going to wear eye protection and it's important to note that my glasses do not count as eye protection. I need to wear additional protection on top of my glasses. And the final steps are my gloves. The gloves need to be pulled down so that they go over the cuff of the gown so that at no point would any of my hand or wrist or forearm be exposed to anything.
So that's how I dawn or put on my PPE. To remove my PPE, I start with my gloves and this is really key to think about while I'm doing this. These are dirty. That's hard to remember sometimes in lab because usually you do what I just did, right? You put it on. You take it off. You put it on. You take it off. But in real life I have touched something that's contaminated or been in a patient's room that's on precautions or whatever it is so my hands are dirty so I need to be careful when I take them off. I'm going to pull it by the lower cuff, not inside, and I'm going to slip it off. I'm going to roll it up and then with this hand I'm going to slip it up under that and roll that off and I'm going to dispose of these. So I would throw those away.
Next I'm going to remove my eyewear and I want to touch as far back as I can, right? The front of my face is contaminated and exposed so I'm going to touch way back here. I'm going to remove my eyewear and I would either discard these or a lot of facilities now have you clean them and reuse them so I would at least set them aside. I'm going to remove my gown so I'm going to pick it up by the cuff and slip it over and then I'm going to do this one. Whoop, I got to untie it first. Hang on a second. All right. I'm going to untie it first. So in real life I often break them but since I want to reuse my gown in lab-- whoop, I broke it. I'm going to break it anyway. All right.
Now I want to roll it down, remove my hands by touching the cuff, right? And the farthest part of the cuff was protected by my glove cuff so that's safe to touch and then I want to touch it by the inside that was against me and I can then dispose of that as well. Then the last step is the mask and again I'm going to pull it from the back ear loops. Not from the front, from the back ear loops. I'm sure during this season you have seen lots of people move their masks up and down like this and all they're doing is touching the contaminated part that you're not supposed to be in contact with.
So I'm going to remove it from my ear loops, pull it straight away from my face, and dispose of that as well. And the reason why your mask is last is because you have to remove all of this inside the patient's room, right? You can't leave the patient's room with any of this on or you're just bringing whatever that contamination is out into the general population so I remove all the things that I can touch someone with or has been touched by someone and then I remove my mask on my way out the door. That's how I dawn and doff my PPE.
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