Donning and Doffing PPE During COVID-19

Blog

Personal protective equipment (PPE) is a regular part of being a direct care provider and important for protecting yourself and your patients. With concerns about availability, it is necessary to understand current recommendations and safe techniques for donning and doffing PPE.

Evidence regarding the extended use and decontamination of PPE continues to evolve. Please visit the CDC and FDA websites for their latest recommendations.

How does the virus spread?

Information continues to emerge daily as more research is completed regarding COVID-19 and the availability and manufacturing of PPE evolve. It is essential to continue to monitor information from credible governmental organizations such as the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO) and The Joint Commission. CDC recommendations released on March 31, 2020, offer suggestions to decrease the possibility of transmission in your facility, prepare for patient isolation and protect staff.

Based on our current understanding, the risk for transmission is greatest during close person-to-person contact when infected individuals produce respiratory droplets by coughing, sneezing or talking. Asymptomatic individuals are still able to spread the virus. Since it is unlikely transmission can occur over long distances, social distancing guidelines have been suggested to limit virus spread.

How can you protect yourself?

With thoughtful consideration, you can help your organization plan for the care of patients during the COVID-19 crisis. The American Nurses Association has developed a free webinar (requires registration) that provides great information and insight into planning to protect you and your staff.

Most crucial is hand hygiene before and after all patient contact, during contact with potentially infectious material or surfaces, and before donning and doffing PPE. The CDC has published a PDF with preferred and acceptable alternative PPE for healthcare personnel related to COVID-19. Precautions must be taken when performing aerosol-generating procedures such as those likely to induce coughing.

What are the best practices for using PPE?

In addition to using the correct PPE for confirmed or suspected COVID-19, it is equally important to follow correct procedures for donning and doffing PPE. Based on CDC guidance, the donning procedure should include the followng:

1Gather appropriate PPE - ensure the appropriate size of equipment before beginning
2Perform hand hygiene using hand sanitizer
3Don isolation gown - ensure ties are secure
4Don respirator/face mask - ensure appropriate fit, particularly for those with facial hair
5Put on face shield/goggles - note that face shields provide full face protection
6Perform hand hygiene again prior to donning gloves - ensure gloves go on top of gown cuff

Doffing PPE is equally important, as transmission risk is still present.

1While in the patient’s room, remove gloves without contaminating hands. Make sure the glove is turned inside out as you remove it.
2Remove gown - Untie/unsnap ties, break ties if applicable. Remove by grabbing one shoulder at a time to remove each arm, continue to pull gown down and away from the body. Roll gown as it is removed and place in the proper receptacle. You may now exit the room.
3Upon exit, perform hand hygiene - via handwashing or hand sanitizer
4Remove face shield/goggles - use strap or sides, do not contact the front of them
5Remove and properly handle respirator/face mask - do not contact the front, and dispose or decontaminate as appropriate
6Repeat hand hygiene again

For additional infographics please see:

While this information presents you with one procedure for donning and doffing PPE, it is crucial that you follow your organization’s policies and procedures regarding PPE. Most importantly, be sure to perform hand hygiene.

How could you help educate others about the appropriate use of PPE?

Michelle Sanchez, MSN, RN

Beacon Program Manager, American Association of Critical-Care Nurses

Michelle has been with AACN since 2012. She has extensive leadership, quality and safety experience from various roles in perioperative services, including Clinical Director of an ambulatory surgery center.

6 Comments

What about Donning and Doffing of equipment that has been used?

Remove

Mackenzie Field

03:45 PM · April 11, 2020 edited

Great question and I apologize for not responding sooner. Check with your hospital's recommendations about donning and doffing used equipment. Equipm ... ent that has been used should have gone through a cleaning process prior to reuse. Read More

Remove

Caryl Goodyear

12:02 PM · April 15, 2020 edited

At my current COVID crisis Travel RN assignment where the majority of pts are COVID positive you can imagine how much equipment is in use or being sha ... red. The facility has come up with a fairly reasonable plan of action. Staff has been fitted twice for KN-95 and N-95 each staff member is given a respirator to use while on shift. With the mask they also give us a plastic bag labeled with our names. Each mask is to last for a work week if possible to conserve for the future. At the end of your shift place it in your plastic bag and leave it at work for your next shift. Most nurses now a days do 12 hr shifts not all but most so this is 3 days/nights a week. If the mask gets wet or becomes compromised then we just ask the charge nurse for another mask. We also have the option of using standard PaPAR helmets with standard face shields. I tend to like them more because of the continuous flow of oxygen. When done using wipe off helmet and keep shield in your bag. It’s simple and it works Read More

Remove

Joyella Jones

08:46 PM · May 29, 2020 edited

I would like to know why the same standard for donning PPE in the OR could not be used for PPE in the other areas where PPE is necessary. 1 Wash han ... ds 2. Head coverings, mask and googles/ protective googles and face masks Rationale: Allows for touching facial areas once 3. Wash hands and don gown; taking care to ensure the back is covered completely Rational: Ensures there is no gaps that can cause contamination when gown is removed Donning the gown; make sure that the hands are so the fingers of each hand are exposed enough to pick up the gloves after the gown is on and secured 4. Wash HANDS and DRY THOROUGHLY. 5. The dominate hand; pick up the first glove by the cuff and pull in over the non dominate hand; with the non dominate hand take the second glove and pull is over the dominate hand. Rational: The gloves are then over the the cuff of the gown with minimal risk of contamination. If shoe covers are to be worn these go on first. Read More

Remove

Bess Hannigan

10:56 AM · May 30, 2020 edited

As a previous OR nurse, I felt knowledgeable about donning and doffing PPE until I reviewed the guidelines included in this document. While I cannot ... speak to their rationale, I do see that their steps should still result in containing contaminated items and minimize possible exposure for staff. As always, following hospital guidelines is a must to ensure consistency in protecting yourself and others. Read More

Remove

Michelle Sanchez

09:02 AM · June 30, 2020 edited

We have been told time and time again to reuse our paper yellow isolation gowns for the whole day for our COVID patients in the ICU. We hang them eith ... er inside the room by the door or outside the door. Thoughts on that? Read More

Remove

Norrine Buchholz

08:27 AM · December 30, 2020 edited