Personal Protective Equipment: Selection, Donning, and Doffing

Why PPE Selection Matters

Personal protective equipment (PPE) is your frontline defense against transmitting or acquiring infection during patient care. Choosing the wrong PPE — or removing it in the wrong order — can expose you, your patient, or your coworkers to harmful pathogens. State CNA competency evaluations and real facility practice both require you to select, don, and doff PPE correctly every time. A single self-contamination error during doffing can undo every protective measure you took during the entire care task.

Transmission-Based Precautions and PPE Selection

Standard precautions apply to all patients at all times: hand hygiene, gloves when touching blood or body fluids, and a mask or eye protection when splashing is possible. Beyond standard precautions, the CDC defines three transmission-based precaution categories that drive your PPE choices.

Contact precautions (example: MRSA, C. difficile, wound infections) require a gown and gloves before entering the room. The pathogen spreads by direct or indirect touch, so covering your skin and clothing is essential.

Droplet precautions (example: influenza, pertussis, mumps) require a surgical mask worn upon entering the room, plus a gown and gloves when direct care involves close contact. Large respiratory droplets fall quickly and do not travel far through the air.

Airborne precautions (example: suspected or confirmed tuberculosis, measles, varicella) require an N95 respirator (or higher), a gown, and gloves. The pathogen travels on tiny particles that remain suspended in the air. Only a fit-tested, seal-checked N95 or powered air-purifying respirator (PAPR) provides adequate protection — a standard surgical mask is not sufficient.

Some patients require a combination. For example, a patient with chickenpox requires both airborne and contact precautions, so you would use an N95, gown, gloves, and eye protection if splashing is likely.

Use the CDC PPE selection guide and your facility's posted precaution signs together. If a sign says "Contact + Droplet," gather everything required for both categories before you enter.

The Donning Sequence

Don PPE outside the patient room, before entering. The correct order keeps cleaner items from being contaminated by items you put on first.

1. Perform hand hygiene — wash or use alcohol-based hand rub.

2. Gown — unfold, slip arms in, tie at neck, then tie at waist. The gown covers your clothing and skin.

3. Mask or respirator — place over nose and mouth; mold the nose wire; for an N95, perform a seal check (positive and negative pressure checks).

4. Eye protection — place goggles or face shield over eyes and face; adjust for fit.

5. Gloves — pull on last; extend cuffs over the gown's wrist edge.

Memory cue: G-M-E-G (Gown, Mask, Eyes, Gloves).

The Doffing Sequence

Doffing is higher risk than donning because the outside surfaces of your PPE are contaminated. The rule is: outside is dirty, inside is clean; gloves are dirtiest, face is most vulnerable. Remove the dirtiest items first, and never touch the outside of a removed item with a bare hand.

1. Gloves — pinch the outside of one glove near the wrist; peel it off turning it inside-out; hold it in the gloved hand; slide fingers of the bare hand under the remaining glove cuff; peel it off over the first glove; discard both together.

2. Perform hand hygiene.

3. Gown — grasp the ties or break them; pull the gown away from shoulders using only the inside or ties; roll it away from you so the contaminated outside is balled inward; discard without shaking.

4. Perform hand hygiene.

5. Eye protection — grasp the earpieces or headband only (not the front lens); lift away; discard or place in designated reprocessing container.

6. Mask or respirator — grasp ties or ear loops from behind (do not touch the front); remove; discard.

7. Perform hand hygiene.

Note: Some facilities sequence eye protection before the gown. Follow your facility's posted checklist and the CDC guidance because both are acceptable; what matters is never touching contaminated outer surfaces with bare skin.

Self-Contamination: Recognizing and Correcting Errors

Self-contamination means a clean body surface or the inside of a PPE item contacts a contaminated outer surface. Common errors include:

• Touching the front of the mask when removing it.
• Snapping gloves off so they contact the wrist or forearm.
• Letting a removed gown touch the floor and then picking it up.
• Skipping hand hygiene between steps.

If an observer flags a self-contamination event during practice, stop immediately, acknowledge the error aloud, perform hand hygiene, and repeat the affected step. This habit builds the reflexive awareness needed in real clinical settings.

N95 Respirators: Fit Testing and Seal Check

N95 respirators must be fit-tested by a qualified person before use in a facility — fit testing confirms the respirator seals correctly to your face shape. Without a proper seal, an N95 provides no airborne protection advantage over a surgical mask. Before each use, perform a user seal check: cover the respirator and exhale sharply (positive pressure check) or inhale sharply (negative pressure check) to detect leaks. CNAs in facilities that use N95s will be fit-tested by the employer; you are not expected to conduct fit testing yourself, but you must understand why it is required.

Waste Disposal

All used PPE is treated as regulated medical waste unless facility policy states otherwise. Discard into a waste bin lined with a red biohazard bag inside the patient room or just outside the door, following your facility's procedure. Never carry contaminated PPE through the hallway to a distant waste bin.