Personal Protective Equipment (PPE): Types, Selection, and Donning/Doffing Sequence

Personal protective equipment (PPE) is a cornerstone of infection control in nursing practice. This note reviews the main types of PPE, when each is indicated, and the correct sequence for donning and doffing — all common targets on the NCLEX and other nursing exams.

Definition

Personal protective equipment (PPE) is specialized clothing and equipment used to protect healthcare workers from exposure to infectious materials. It is a key component of standard precautions and transmission-based precautions.

The five main types of PPE are:

• Gloves
• Gowns
• Surgical masks
• N95 respirators
• Eye protection (goggles or face shields)

Types of PPE and Their Indications

• Gloves — Protect hands from blood, body fluids, and contaminated surfaces. Use when touching blood, body fluids, mucous membranes, or non-intact skin.
• Gown — Protects skin and clothing from splashes or sprays. Use during procedures likely to generate splashes or sprays of body fluids.
• Surgical mask — Protects against large respiratory droplets (within ~3 feet). Use for droplet precautions and routine procedures with splash risk.
• N95 respirator — Filters airborne particles, including droplet nuclei. Use for airborne precautions (TB, measles, varicella).
• Eye protection — Protects eyes from splashes or sprays. Use when splashes or sprays of body fluids are anticipated.

Key points about each type

• Gloves are the most commonly used PPE. Change gloves between patients and between dirty and clean procedures on the same patient.
• Gowns should be removed before leaving the patient's room. The front and sleeves of the gown are considered contaminated.
• Surgical masks protect against large droplets but do not seal tightly to the face — they are not effective for airborne precautions.
• N95 respirators form a tight seal around the nose and mouth. You must be fit-tested before use.
• Eye protection includes goggles and face shields. A face shield also covers the nose and mouth, but a mask is usually still needed underneath.

Selection of PPE by Transmission Route

• Standard precautions (routine care): Gloves if contact with blood or body fluids is anticipated; gown or mask only for specific tasks.
• Contact precautions: Gloves and gown for every patient entry.
• Droplet precautions: Surgical mask (plus eye protection if splash risk).
• Airborne precautions: N95 respirator plus a negative pressure room.

Donning (Putting On) PPE — Correct Order

Putting on PPE in the correct order prevents contamination:

1. Perform hand hygiene before touching any PPE.
2. Put on the gown first. Tie it securely at the neck and waist.
3. Put on the mask or N95 respirator over the nose and mouth. For an N95, perform a user seal check (cover the mask and exhale sharply to feel for leaks).
4. Put on eye protection (goggles or face shield).
5. Put on gloves last. Pull the glove cuffs over the gown cuffs to cover your wrists.

Cautions when donning:

• Do not put on gloves before the gown — gloves must cover the gown cuff.
• Do not touch the front of the mask or respirator while donning; handle it by the straps only.
• Always perform a seal check after donning an N95.

Doffing (Removing) PPE — Correct Order

Removal is higher risk than donning because the outside of PPE is contaminated. Follow this sequence:

1. Remove gloves first. Grasp the outside of one glove with the opposite gloved hand, peel it off, and hold it in your gloved hand. Slide bare fingers under the cuff of the second glove and peel it off, turning it inside out. Dispose of both gloves.
2. Remove the gown. Unfasten the ties, pull the gown away from the neck and shoulders, and roll it inside out away from your body. Dispose of it appropriately.
3. Perform hand hygiene.
4. Remove eye protection by handling the headband or earpieces only — do not touch the front.
5. Remove the mask or N95 respirator. Lean forward slightly and remove it by the bottom strap first, then the top strap. Do not touch the front of the mask.
6. Perform hand hygiene again after removing all PPE.

Cautions when doffing:

• Do not touch the front of any PPE — these surfaces are contaminated.
• Do not shake or snap PPE, as this aerosolizes pathogens.
• Move deliberately; do not rush.

Common Exam Traps

• Do not put on gloves before the gown. Gloves go over gown cuffs.
• Do not touch the front of the mask, goggles, face shield, or gown during removal.
• Do not remove the mask before the gown. Correct order is gloves → gown → eye protection → mask last.
• Do not wear the same gloves for multiple patients. Change gloves and perform hand hygiene between patients.
• Do not forget to perform a seal check after donning an N95 respirator.

Key takeaways

• The five types of PPE are gloves, gowns, surgical masks, N95 respirators, and eye protection — match each to the precaution type.
• Contact = gloves + gown, droplet = surgical mask, airborne = N95 + negative pressure room.
• Donning order: hand hygiene → gown → mask/N95 → eye protection → gloves (over the gown cuff).
• Doffing order: gloves → gown → hand hygiene → eye protection → mask/N95 → hand hygiene again.
• N95 respirators require fit testing and a user seal check before patient care.
• Never touch the front of contaminated PPE during removal.