PPE Donning and Doffing: Contact, Droplet & Airborne Sequences
Step-by-step PPE donning and doffing for nurses—clean versus dirty zones, bundle selection tied to isolation precautions, respirator fit checks, and how to exit without contaminating skin, clothing, or the corridor.
Contents
Quick Facts
Key Takeaway
Most occupational exposures happen during doffing, not during patient contact: treat the doorway as a contamination boundary—don completely before crossing in, remove PPE in the posted order without touching the front of mask or respirator, then perform hand hygiene in the clean zone before touching phones, charts, or the next patient.
Quick procedure summary
| Field | Details |
|---|---|
| Procedure name | PPE donning and doffing |
| Also known as | PPE application and removal; gown-up and gown-down |
| Category | Infection prevention and control |
| Clinical purpose | Protect staff, patients, and the environment from transmission of infectious agents during care |
| Who performs it | All direct care staff; nurses lead coaching, auditing, and breach reporting |
| Typical duration | About 2–5 minutes per don–care–doff cycle (varies by bundle and room setup) |
| Settings | Isolation rooms, emergency bays, procedural areas, outbreak units, home visits with transmission risk |
What is PPE donning and doffing?
PPE donning and doffing is the structured putting on and removal of personal protective equipment so barriers stay intact from the moment you approach an isolation zone until you return to clean workflow. It sits on top of standard precautions (hand hygiene, safe injection, respiratory etiquette) and implements the PPE elements required by active transmission-based orders—contact, droplet, or airborne.
Nurses use this skill dozens of times per shift: entering a room with watery diarrhea, suctioning a patient with cough, or supporting a pending tuberculosis work-up. Principles align with publicly available standards such as the Royal Marsden Manual — Personal protective equipment (PPE); proprietary step text and illustrations are not reproduced here—follow your licensed manual and posted zone sequence. Institutional protocols may vary, but the bedside rule is consistent: don before crossing the line; doff before touching clean surfaces.
Clean zone versus dirty zone
Think in zones, not individual items. The anteroom (or taped floor line) is where you transition—everything on the patient side of the threshold is potentially contaminated once care begins.
- Hand hygiene station, clean PPE stock, clean pens if policy allows
- Where you finish doffing and perform final hand hygiene
- Never store personal phones or food here if policy restricts them near isolation
- Patient bed space, bathroom, and surfaces touched during care
- Used PPE and waste—discard inside room when policy directs
- Assume gloves are contaminated after any patient or environment touch
Gather medications, linens, and specimen collection tools before donning so a mid-task dash to the clean corridor does not become an unplanned half-doffed breach.
PPE bundles by transmission route
Match the bundle to the chart order—not to habit. Principles below align with CDC transmission-based guidance; your posted sequence may reorder steps.
| Route | Minimum PPE for room entry | Donning emphasis | Doffing emphasis |
|---|---|---|---|
| Contact | Gown + gloves (hand hygiene before and after) | Secure gown at neck and waist; gloves cover gown cuffs | Peel gloves first; roll gown away from body; hand hygiene |
| Droplet | Mask + gown + gloves; eye protection if splash risk | Mask covers nose and mouth before entering; minimise gap at nose bridge | Remove gloves, then gown, then mask by ties/ear loops—avoid touching front |
| Airborne | Fit-tested N95 or equivalent + gown + gloves; eyes if splash risk | Seal check before entry; negative-pressure door closed | Remove respirator last after gown; discard or store per policy; hand hygiene |
On a small screen, swipe or scroll sideways to see the full table.
Choosing the category and room setup is covered in the companion guide: isolation precautions implementation.
Isolation PPE versus sterile gowning
Confusing these pathways is a common root cause of breaches. Sterile gown and glove technique protects a procedure field from your flora; isolation PPE blocks two-way organism transfer during routine or transmission-based care.
| Feature | Isolation PPE | Sterile gown & gloves |
|---|---|---|
| Primary goal | Interrupt transmission to/from patient and environment | Maintain sterility of field and invasive site |
| Typical supplies | Disposable isolation gown, procedure mask or respirator | Sterile peel-pack gown, closed gloving |
| If contaminated | Discard PPE and re-don; report exposure if splash to mucosa | Stop procedure; replace gloves/gown and reset field |
Indications
| Indication | Nursing rationale |
|---|---|
| Active transmission-based precaution order | Legal and clinical requirement before room entry |
| Suspected organism pending results | Protect others while C. difficile toxin assay or sputum culture is processed |
| Tasks with splash or spray risk | Add eye protection even when base order is contact or droplet |
| Unit outbreak or cluster | Consistent donning/doffing audits reduce secondary cases such as norovirus |
When to pause before donning
- No fit-tested respirator when airborne precautions are ordered
- Torn or visibly soiled PPE in the dispenser
- Chart order conflicts with door signage (contact vs airborne)
- Facial hair or fit-test status prevents respirator seal per policy
- Patient agitation makes predictable doffing unlikely—plan two staff
- You have not completed competency for the required bundle
Equipment checklist
Pre-donning checks
Donning sequence (typical workflow)
Follow your facility poster first. The steps below reflect commonly taught CDC-based sequencing for transmission-based care.
Clean zoneHand hygiene
Use soap and water when policy requires (for example spore precautions or visible soil); otherwise alcohol-based rub per hand hygiene guidance.
Don gown
Secure at neck and waist; sleeves fully cover clothing. For airborne bundles, gown often precedes respirator—verify local order.
Don mask or respirator
Procedure mask: mould nose piece, ensure coverage of nose and mouth. Respirator: cup with straps, perform user seal check per training.
Don eye protection
When splash, cough spray, or procedure risk exists. Adjust before gloves when possible to avoid touching face with gloved hands later.
Don gloves
Extend over gown cuffs. IPC checkpoint: hands off face and phone—enter room only when the bundle is complete.
Doffing sequence (typical workflow)
Doff inside the patient zone or anteroom per policy—never walk to the nurses’ station still gloved. Sequence below is a widely taught pattern; your poster is authoritative.
Exit / anteroomRemove gloves
Peel without snapping; avoid touching outer surfaces with bare skin. Discard immediately.
Remove eye protection
Handle by headband or ear pieces; clean reusable shields per policy or discard disposables.
Remove gown
Break ties or peel from shoulders downward; roll contaminated side inward. Discard without shaking.
Remove mask or respirator
Untie or unhook from behind—do not touch the front. For respirators, follow storage or discard rules for extended use programmes.
Hand hygiene in clean zone
Perform immediately. IPC checkpoint: only then touch corridor equipment, keyboards, or the next patient.
High-risk doffing errors
| Error | Why it matters | Safer habit |
|---|---|---|
| Grabbing mask front | Concentrates organisms on fingers that next touch face | Remove by ties, ear loops, or straps behind head |
| Gown rolled outward | Disperses contamination onto shoes and floor | Roll inward; keep gown contained in waste bag |
| Partial doff at cart | Contaminates shared work surfaces | Complete sequence at zone line; hand hygiene before leaving |
| Reusing gloves between tasks | Gloves are not a substitute for hand hygiene | Change gloves when moving from dirty to clean body sites; still wash or rub hands after removal |
PPE breach and occupational exposure
A breach is any unprotected contact with blood, body fluids, secretions, or mucous membranes—or a tear that defeats the barrier. Splashes to eyes during suctioning, needlesticks during dressing changes, or face-touching while gloved all require immediate action per occupational health policy, not “watch and wait.”
- Wash exposed skin or flush mucosa with water or saline as directed
- Report to occupational health or emergency pathway the same shift
- Document patient identifiers, exposure type, and PPE worn
- Continue required precautions for the patient until infection control advises otherwise
New fever or chills in the exposed staff member should trigger urgent review—do not assume it is unrelated without assessment.
Documentation
“Contact precautions: gown and gloves donned before entry; care completed without PPE breach; doffed at anteroom per posted sequence; soap-and-water hand hygiene after glove removal per C. difficile policy; patient tolerated care; no supply issues.”
- Precaution category and any deviation from standard bundle
- Visitor coaching on donning/doffing when visits occur
- PPE breaches, exposures, and occupational health referral numbers
- Low stock or broken dispensers reported to infection control
Clinical pearls
- Say the bundle aloud at handoff (“droplet plus contact”)—visual memory fails on busy nights.
- Keep a “clean hand” discipline: if you touched the mask front, consider hands contaminated until hygiene is performed.
- Pair doffing audits with airway suctioning competencies—splash risk is highest when rushing.
- For spore precautions, soap-and-water after doffing is often mandatory even when alcohol rub was used on entry—read the door card.
Clinical Judgment Practice
Most exposures happen at the glove cuff, not at the bedside—rehearse NCLEX-style clinical judgment practice for PPE donning and doffing: priority action before room entry, select-all-that-apply safe donning cues, post-audit trend interpretation, ordered doffing response, and documentation cloze (recognise cues → analyse → prioritise → act → evaluate outcomes).
Unfolding case — medical ward. Mr. Chen, 72, has profuse watery stools; Clostridioides difficile toxin is pending and contact precautions with soap-and-water hand hygiene are ordered. In the next bay, Ms. Ruiz has confirmed influenza on droplet precautions. You are assigned morning care on both patients and notice the contact room is low on gowns.
Answer key & rationale
Frequently asked questions
What is the correct order for donning PPE?
Many facilities teach gown, then mask or respirator, then eye protection if needed, then gloves—with hand hygiene before starting. Always follow the posted sequence at the isolation zone; institutional protocols may vary.
What is the safest order for removing PPE?
A widely taught pattern is gloves first, then eye protection, gown, and mask or respirator last, followed by hand hygiene in the clean zone. The goal is to avoid touching contaminated outer surfaces with bare hands or face.
Do gloves replace hand hygiene after doffing?
No. Gloves reduce hand contamination during care but do not replace hand hygiene after removal—especially after contact precautions for spore-forming organisms when soap and water is required.
When is a fit-tested respirator required instead of a surgical mask?
When airborne precautions are ordered—for example suspected or confirmed tuberculosis, measles, or varicella in infectious stages. A surgical mask does not replace a respirator for airborne isolation.
How is isolation PPE different from sterile gowning?
Isolation PPE blocks transmission between you and the patient during routine or precaution-ordered care. Sterile gowning protects a sterile procedure field. Supplies, sequences, and reset rules differ.
What should nurses do after a PPE breach or splash?
Immediate local first aid per policy, same-shift reporting to occupational health, documentation of exposure details, and continued patient precautions until advised otherwise.
References
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Centers for Disease Control and Prevention. Isolation Precautions Guideline — HCP hub (PPE and transmission-based precautions).https://www.cdc.gov/infection-control/hcp/isolation-precautions/index.html
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Centers for Disease Control and Prevention. Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings (2007).https://www.cdc.gov/infection-control/media/pdfs/Guideline-Isolation-H.pdf
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Centers for Disease Control and Prevention. Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings.https://www.cdc.gov/infection-control/hcp/core-practices/index.html
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World Health Organization. Infection prevention and control.https://www.who.int/teams/integrated-health-services/infection-prevention-control
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World Health Organization. WHO guidelines on hand hygiene in health care (2009).https://www.who.int/publications/i/item/9789241597906
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The Royal Marsden Manual of Clinical Nursing Procedures — Personal protective equipment (PPE) (Chapter 4 overview).https://www.rmmonline.co.uk/manual/c04-sec-0070
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Royal Marsden Manual — Applying and removing a disposable apron.https://www.rmmonline.co.uk/manual/c04-fea-0009
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Royal Marsden Manual — Putting on and removing a disposable mask or respirator.https://www.rmmonline.co.uk/manual/c04-fea-0010
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Royal Marsden Manual — Procedures hub (general nursing procedure library).https://www.rmmonline.co.uk/contents/procedures
Editorial standards & medical review
About the author: Sid A. Abdala Balal, RN, writes evidence-based nursing education focused on practical bedside skills, patient safety, and clinical decision support for nurses.
Medical review: This guide is reviewed by Dr. Adam Sayedi, MD, for clinical accuracy, clarity, and alignment with current PPE and infection prevention standards.
Policies: Medical Review Process · Editorial Policy · Correction Policy