3 Personal Protective Equipment

Why PPE matters

Personal protective equipment (PPE) creates barriers between healthcare workers and infectious material. It includes gloves, gowns, masks, respirators, goggles, and face shields. Correct selection and use reduce exposure risk, but PPE does not replace hand hygiene, safe work practices, or other infection-control measures.

Choose PPE according to the task, the exposure anticipated, and the patient’s required precautions. Follow facility instructions and the product’s directions.

Selecting PPE for the task

Begin with Standard Precautions for every patient. Add the PPE required by the patient’s Transmission-Based Precautions and by the task.

• Gloves: Wear them when contact with blood, body fluids, mucous membranes, nonintact skin, or contaminated equipment is reasonably anticipated. Change gloves between tasks if they become contaminated and between patients. Gloves do not replace hand hygiene.

• Gown: Wear one when clothing or skin may contact blood, body fluids, secretions, or excretions. For Contact Precautions, a gown and gloves are generally worn for interactions that may involve contact with the patient or their environment.

• Mask and eye protection: Use a mask with goggles or a face shield when splashes or sprays may reach the nose, mouth, or eyes. Follow the required precautions for respiratory infections.

• Respirator: For Airborne Precautions, use the required fit-tested, NIOSH-approved respirator, such as an N95 or higher-level respirator. Meet medical-clearance and fit-testing requirements, and check the seal each time it is put on.

Routine care with no expected body-fluid exposure may require no gown or gloves under Standard Precautions. Cleaning a substantial body-fluid spill requires appropriate gloves and protective clothing, with eye and face protection if splashing is possible. Follow disease-specific and facility guidance when it calls for additional protection.

Putting on PPE

Prepare before entering the care area: read the precaution sign, gather the correct size and type of PPE, and identify where used items will be discarded. Perform hand hygiene. A common donning sequence is:

1. Gown: Cover the torso from neck to knees and arms to the wrists; fasten at the back.

2. Mask or respirator: Secure it over the nose and under the chin. For a respirator, perform a user seal check according to its instructions.

3. Goggles or face shield: Adjust to cover the eyes and face as needed.

4. Gloves: Put them on last, extending the cuffs over the gown sleeves.

The exact sequence can vary with the equipment and facility protocol. Before care, check that PPE fits, covers the intended areas, and is not torn or damaged. Keep hands away from the face and limit contact with nearby surfaces.

Removing PPE safely

PPE surfaces that faced the patient or environment are considered contaminated. Remove items slowly, without touching the face, clothing, or clean skin with contaminated surfaces. Follow posted removal instructions; a common doffing sequence is:

1. Gloves and gown: Remove them carefully, turning contaminated surfaces inward. If removing them together, peel the gown away from the body while turning it inside out and containing the gloves within it. Discard them in the designated container.

2. Hand hygiene: Clean hands after removing gloves and gown, especially if hands may have been contaminated.

3. Eye protection: Handle it only by the clean straps, arms, or headband. Put reusable equipment in its designated reprocessing container; discard single-use items as directed.

4. Mask or respirator: Avoid touching the front. Remove it using ties or straps. For a respirator, leave the room and close the door before removing it when required by the precautions or facility procedure.

5. Hand hygiene: Perform hand hygiene after all PPE is removed and disposed of.

If hands or clothing become contaminated during removal, stop, remove the contaminated item safely, and perform hand hygiene. Follow facility procedures for exposure or contamination.

Disposal and reuse

Discard single-use PPE in the designated waste container at the point of removal. Place reusable items in the designated container for cleaning and disinfection, and contaminated linen in the facility’s designated laundry receptacle. Do not take used PPE into clean areas, reuse disposable gloves, or wash gloves for reuse.

Reuse or extended use of other items is appropriate only when specifically permitted by current guidance and facility policy. Perform hand hygiene after disposal.