Putting on personal protective equipment follows a specific sequence: hand hygiene, gown, mask or respirator, eye protection, then gloves. The order matters because each layer builds on the last, and skipping steps or reversing the sequence creates gaps where skin stays exposed. Here’s how to do it correctly, piece by piece.
The Correct Donning Sequence
The CDC recommends this order for full PPE:
- Hand hygiene (wash with soap or use alcohol-based hand rub)
- Gown
- Mask or respirator
- Eye protection (goggles or face shield)
- Gloves
Gloves go on last for a reason: they need to cover the cuffs of your gown at the wrist, creating a continuous barrier from your torso to your fingertips. If you put gloves on before the gown, you lose that overlap and leave a strip of exposed skin.
Inspect Everything Before You Start
Before putting anything on, check each item for defects. For gloves, look for tears, punctures, discoloration, or stiffness. If you want to be thorough, fill them with water and roll the cuff toward the fingers to reveal pinhole leaks. Discolored or stiff gloves may have degraded from chemical exposure and should be thrown out.
Check gowns for rips and make sure you have the right size. A gown that’s too large is a real problem: in one study of healthcare workers, oversized coveralls dragged on the floor during donning about 11% of the time, picking up contamination before the worker even entered the patient room. Also confirm that your respirator is the correct model and size for your face.
Putting On the Gown
After cleaning your hands, the gown goes on first. Open it fully so you can slide your arms through the sleeves without bunching. Tie all the ties, both at the neck and the waist. If you can’t reach a tie behind your back, ask someone to help rather than leaving it loose. An untied gown shifts and gaps during movement, defeating its purpose.
Choose a gown that fits your body. If it’s too long, the hem can touch the floor while you’re stepping into it. Stand balanced on both feet as you put it on. Workers who tried to step into coveralls while standing on one foot lost their balance and let the fabric drag on the ground nearly 9% of the time in observational studies.
Fitting the Mask or Respirator
This is the step where mistakes happen most often. In one study tracking donning errors, failure to properly check the respirator seal was the single most common mistake, occurring in over 13% of attempts. A poorly sealed respirator lets airborne particles slip through gaps around your nose and cheeks, which essentially makes it decorative.
For an N95 respirator, place it over your nose and mouth so it sits under your chin. Position the top strap on the crown of your head and the bottom strap at the base of your neck. Then, using both hands, mold the metal nosepiece to the shape of your nose by pressing inward with your fingertips. Do not pinch the nosepiece with one hand, as this creates a tent shape with gaps on either side.
Once the respirator is positioned, perform a seal check every time. Cover the entire front of the respirator with both hands and exhale sharply. If you feel air leaking around your nose, cheeks, or chin, readjust the straps and nosepiece and try again. Do not use the respirator until you can exhale without feeling any air escaping around the edges.
For a standard surgical mask with ties, secure the top tie at the crown of your head and the bottom tie at the base of your neck. If it has ear loops, hook them around your ears and pinch the nosepiece snug. Never wear a mask or respirator dangling under your chin or stuff it into a pocket between uses.
Adding Eye Protection
Goggles or a face shield go on after your respirator is sealed. This order prevents the eye protection from interfering with the respirator’s fit. If you put goggles on first and then try to adjust your respirator straps around them, you’re likely to knock the seal loose.
Face shields cover more area and protect the full face. Goggles give excellent eye protection but tend to fog up, especially during extended wear. Whichever you choose, make sure it sits securely without pressing on or shifting the respirator beneath it.
Putting On Gloves
Gloves are the final piece. Pull each glove up so the cuff extends over the wrist of your gown sleeve. This overlap is critical: your hands make the most contact with contaminated surfaces, and any gap between glove and gown creates a direct path to your skin.
After pulling them on, visually inspect the seal where glove meets gown. In the same observational study mentioned above, about 4.5% of workers failed to check whether their gloves were properly sealed. Since hands are the body part most frequently exposed to contaminants, a broken or poorly fitting glove is one of the greatest infection risks for anyone wearing PPE.
How to Safely Remove PPE
Taking PPE off is actually riskier than putting it on, because the outer surfaces are now contaminated. The removal sequence is essentially the reverse of donning, with one key addition: you perform hand hygiene between every single step.
- Remove gloves (they’re the most contaminated item)
- Hand hygiene
- Remove gown
- Hand hygiene
- Remove eye protection
- Hand hygiene
- Remove mask or respirator
- Hand hygiene
That’s four rounds of hand washing or hand rub during a single removal. It sounds excessive, but each step involves touching a contaminated surface, and cleaning your hands immediately prevents you from transferring whatever is on that surface to the next thing you touch. For respirators, remove them outside the patient’s room or in a transition area, since the respirator is the last barrier protecting your airway.
When removing gloves, peel from the outside without touching your bare skin with the glove’s outer surface. A common technique: pinch the outside of one glove near the wrist and peel it off, holding the removed glove in your still-gloved hand, then slide a finger under the wrist of the remaining glove and peel it off inside out, enclosing the first glove inside it. For gowns, untie the ties, pull the gown away from your body so the contaminated front folds inward, and roll it into a bundle before discarding.
Mistakes That Compromise Protection
The most frequent errors during donning are surprisingly simple. Skipping the respirator seal check tops the list. Choosing a gown or coverall that doesn’t fit your body is second: too large and it drags on the floor, too small and it gaps at the closures. Forgetting to fully close zippers or fasteners is another common one, leaving strips of clothing or skin exposed underneath.
Rushing through the process causes most of these problems. Each step takes only seconds when done correctly, but doing them out of order or skipping the inspection creates vulnerabilities that last the entire time you’re wearing the equipment. If you’re in a setting where PPE use is routine, practicing the sequence until it becomes automatic is the single most effective way to avoid errors.