What does PPE stand for?
PPE stands for “personal protective equipment.”
It is specialized clothing or equipment with the goal of protecting healthcare workers by creating a barrier between the healthcare personnel and infectious germs. Additionally, it prevents the spread of infections between clients.
Examples of PPE are gloves, gowns, goggles, face shields, and masks.
Order of donning and doffing PPE
Always perform hand hygiene before and after donning and doffing PPE.
While there are variations, there is a typical order in which PPE is put on to minimize the chances for contamination:
- Gown
- Mask or respirator
- Goggles or face shield
- Gloves
When taking off the PPE, the order can vary a little. In any case, the gloves should be the first to go since they’re likely the most contaminated. The mask and respirator are always taken off last (outside of the room with the door closed).
The goggles or face shield can be the step after removing the gloves, followed by the gown and the mask/respirator being removed last.
Another option is to remove the gown directly after the gloves, then goggles or face shield, and the mask/respirator last.
Since your hands may be contaminated while removing PPE, immediately wash them after doffing personal protective equipment.
Contact precautions PPE
Contact precautions may be, for example, for clients with MRSA, VRW or C. diff. Gowns and gloves are the most common equipment used for contact precautions, but precautions may include other measures like a hairnet.
Gowns
Gowns are for one client use only, and you would switch to a new one for the next client. The gown should cover the torso and at least down to the knees.
Donning the gown:
- Select the appropriate size.
- Put on the gown with the opening at the back.
- Fasten the ties at the neck and waist to ensure the gown fits securely.
You may see nurses skip the step of fastening the ties, especially when they’re in a hurry. Remember ideally to do this step to keep your PPE from falling forward while you’re doing client care.
Doffing the gown:
- Unfasten the waist tie, then the neck tie.
- Pull the gown away from the neck and shoulders, touching only the inside.
- Turn the gown inside out, roll it into a bundle, and dispose of it properly.
Remember that the outside of the gown is always considered contaminated, even if you can’t visibly see any stains. Don’t pull it away by grabbing the part covering your chest.
Gloves
Donning gloves:
- Select glove size.
- Grasp first glove at cuff and slide on hand.
- Put on the second glove by grasping it at the cuff and sliding your hand into it.
Always make sure the gloves go over the cover of the gown.
Doffing gloves:
- Grasp the outside of one glove at the wrist and peel it away, turning it inside out.
- Hold the removed glove in the gloved hand and slide fingers of the ungloved hand under the remaining glove at the wrist.
- Peel off the second glove, trapping the first glove inside, and dispose of properly.
Droplet precautions PPE and airborne precautions PPE
Droplet precautions are, for example, put in place for clients with the flu or RSV. Airborne precautions are needed for clients with, for example, tuberculosis or COVID.
To prevent droplet transmission to the mucus membranes, the most common PPE measure is wearing a surgical mask when within 3 ft (91 cm) of a client.
For airborne precaution, a particulate N95 respirator is needed instead of only a surgical mask. Negative pressure isolation rooms help trap infectious particles.
Mask and/or respirator
Donning mask or respirator:
- Select appropriate mask/respirator and secure it snugly over nose and mouth.
- For masks, secure the ties or bands at the middle of the head and neck.
- For respirators, mold the nosepiece snugly over the nose and cheeks. Pull the top strap over the head to the crown and the bottom strap to the nape of your neck.
- Perform a fit check to ensure no air leaks.
Note: Proper fit testing is important and should be done when you start as a new nurse at a new facility during orientation. During the test, the evaluator sprays an aerosol (e.g. saccharin that would taste sweet) near the employee (who may be wearing a hood covering over the head/neck) who then determines if they can perceive (taste) it despite the respirator. This positive taste would indicate an imperfect seal and a problem with the fit.
Doffing mask or respirator:
- Remove the mask/respirator without touching the front.
- For masks, untie the bottom tie first, then the top tie, and pull the mask away from the face.
- For respirators, remove the bottom strap by pulling it over the head without touching the respirator.
- Remove the top strap by pulling it over the head.
Goggles and face shields for eye protection
Donning eye protection:
- Place the goggles or face shield over the eyes.
- Adjust for a secure fit. The protection should not slide down during client care.
- Ensure it covers the sides of the face and the eyes.
Doffing eye protection:
- Remove the eye protection without touching the front.
- Grasp the straps or sides and lift it away from the face
- Properly dispose of or clean it.
FAQs around PPE responsibilities
Who is responsible for buying PPE?
Providing adequate personal protective equipment is the responsibility of the employer, who will typically have processes set up for buying all necessary equipment.
Who is responsible for making sure that workers know how and when to use PPE?
Employers are always responsible for training around PPE, including when and how to use which equipment, and proper maintenance and disposal.
Who is responsible for making sure that PPE fits each worker properly?
Employers must make sure that every employee has access to PPE that fits them properly. That responsibility does not exclude cases where the employee provides the PPE themselves.
