The correct order for putting on PPE is: hand hygiene first, then gown, then mask or respirator, then eye protection, then gloves last. This sequence moves from largest coverage area to smallest, ensuring each layer overlaps properly with the one before it. Getting the order wrong can leave gaps in protection or contaminate equipment before you even enter a patient’s room.
Why the Order Matters
Each piece of PPE is designed to overlap with the one applied before it. The gown goes on first because its cuffs need to be tucked under the gloves. The mask goes on before eye protection so goggles or a face shield can sit over the straps and help hold everything in place. Gloves go on last because they cover the gown’s wrist cuffs, creating a continuous barrier from fingertip to body. Reversing any of these steps breaks that chain of coverage.
The sequence also protects the equipment itself. If you put gloves on too early, you risk contaminating them while adjusting your gown ties or fitting your respirator. Touching your face to position a mask after gloving defeats the purpose of having clean gloves when you reach the patient.
Step 1: Wash or Sanitize Your Hands
Before touching any equipment, perform thorough hand hygiene with soap and water or an alcohol-based hand rub. This prevents transferring bacteria or viruses onto clean PPE as you handle it. Your hands will contact every piece of equipment during donning, so starting clean is non-negotiable.
Step 2: Inspect Your Equipment
Before putting anything on, give each item a quick visual check. For gloves, look for discoloration, holes, tears, or thin spots. For gowns, check that ties are intact and there are no rips at stress points like the shoulders, elbows, and back. For respirators, confirm the straps are elastic and the nose piece bends properly. Tight-fitting garments are more likely to tear at the knees, crotch, shoulders, and elbows, so pay extra attention to those areas on gowns. A defective piece of PPE discovered mid-procedure is far worse than one caught beforehand.
Step 3: Put On the Gown
Open the gown and slip your arms through the sleeves. The opening should be at the back. Secure the tie or fastener at the neck first, then tie the waist ties. The gown should cover your torso from neck to knees and wrap around your back. If the gown has thumb loops or elastic wrist cuffs, pull them into position now so the sleeves extend as far toward your hands as possible. This overlap zone is where your gloves will eventually seal against the gown.
If you’re using shoe covers, put those on before the gown so you don’t have to bend down later and risk dislodging your mask or eye protection.
Step 4: Put On the Mask or Respirator
For a standard surgical mask, place it over your nose and mouth, loop the ear loops or tie the strings behind your head, and press the metal nose strip to conform to the bridge of your nose. The mask should fit snugly with no large gaps at the sides.
For an N95 respirator, the fit is more critical. Position the respirator over your nose and mouth, pull the top strap over your head to rest above your ears, and pull the bottom strap below your ears around your neck. Mold the nose clip with both hands. Then perform a seal check: place both hands over the respirator, covering as much surface as possible, and breathe out firmly. If you feel air leaking from the edges, or your glasses fog up, the seal is not adequate. Readjust the straps and nose clip and try again. If you still can’t get a tight seal, you need a different size or model.
Check for gaps every single time you put on an N95. A respirator that passed a fit test months ago can still fail on a given day if it’s positioned slightly differently.
Step 5: Put On Eye Protection
Goggles or a face shield go on after the mask. This is intentional: the eye protection sits over the respirator straps and the edges of the mask, adding an extra layer of security and helping keep everything in position. If you wear prescription glasses, know that they do not count as eye protection on their own. You still need goggles or a face shield worn over them.
If you’re using a hair cover or scrub cap, it should already be on before the eye protection step, with both ears fully covered. Eye protection then goes over the cap and respirator together, holding the layers in place as a unit.
Step 6: Put On Gloves
Gloves are always the last item. Select the correct size so they fit snugly without being so tight they’re likely to tear during use. Pull each glove up and over the cuff of the gown so that no skin is exposed at the wrist. This overlap is the critical seal point. If the gown has thumb loops, the glove should cover them completely.
Once your gloves are on, avoid touching anything outside the work area. Your gloves are now the outermost barrier and the first thing that will contact contaminated surfaces.
The Complete Sequence at a Glance
- Hand hygiene
- Shoe covers (if applicable)
- Gown (neck tie first, then waist)
- Mask or respirator (with seal check for N95s)
- Eye protection (goggles or face shield, over the mask)
- Gloves (pulled over gown cuffs)
Using a Buddy to Verify Your PPE
Having a second person watch you put on PPE significantly reduces errors. In hospital settings, a trained observer, sometimes called a “buddy,” watches each step and flags problems like exposed skin at the wrists, a poorly sealed respirator, or a gown that isn’t fully tied. Research published in a critical care setting found that onsite buddies identified correct and incorrect PPE procedures with 99.7% accuracy. Even remote buddies monitoring through a video feed achieved 98.7% accuracy, which makes video-based buddy checks a practical alternative when an in-person observer isn’t available.
If you work in a setting where formal buddy systems aren’t in place, even a quick check with a coworker before entering a contaminated area is better than relying on your own assessment. It’s difficult to see your own back, check your own seal, or notice a small tear at your elbow.
Common Mistakes That Compromise Protection
The most frequent error is putting gloves on too early. If you glove up before your gown and mask, you’ll contaminate the gloves while adjusting other equipment. Another common mistake is skipping the N95 seal check. Without confirming the seal, you might spend an entire shift breathing through gaps at the edges rather than through the filter material.
Loose gown ties are a subtler problem. If the waist tie is unfastened or barely knotted, the gown can shift and expose clothing underneath, which can then carry contaminants out of the room. Similarly, failing to extend gloves over the gown cuffs leaves a strip of exposed wrist skin, one of the most common breach points in PPE setups.
Proper fit also matters at a regulatory level. As of January 2025, OSHA requires that all PPE properly fits each individual worker across construction, general industry, and maritime sectors. “Properly fits” means equipment selected for your specific body dimensions, not a one-size-fits-all approach. If your gown is too tight, it’s more likely to tear at the shoulders and elbows. If your gloves are too loose, they reduce dexterity and can slip off during procedures.