The correct order for putting on personal protective equipment is: hand hygiene first, then gown, mask or respirator, eye protection, and gloves last. This sequence matters because each layer builds on the one before it, creating a continuous barrier with no exposed gaps. Getting the order wrong, or skipping a step, can leave skin exposed at transition points like your wrists or neckline.
Start With Hand Hygiene
Before you touch any piece of equipment, clean your hands. Use soap and water or an alcohol-based hand rub for at least 15 seconds, covering your palms, the backs of each hand, your fingertips, between your fingers, and the base of each thumb. This prevents transferring anything from your hands onto clean equipment as you put it on.
Step 1: Gown
The gown goes on first because it’s the base layer that other pieces overlap. Pull it on so it fully covers your torso from your neck down to your knees, with sleeves reaching to the end of each wrist. Wrap it around your back so there are no gaps, then fasten the ties at the neck and waist. If the gown is too short or too narrow to close completely in the back, size up. Any exposed clothing or skin underneath defeats the purpose.
Step 2: Mask or Respirator
The type of mask you need depends on the situation. A standard surgical mask is used for droplet precautions, protecting against larger respiratory particles that travel short distances. Airborne precautions require a fit-tested N95 or higher-level respirator, which filters much smaller particles that can linger in the air.
For a surgical mask, place it over your nose and mouth, loop the ear loops or tie the ties at the middle of your head and neck, and press the flexible metal strip over your nose bridge so it conforms to the shape of your face. The mask should sit snug against your cheeks and below your chin with no large gaps at the sides.
How to Fit-Check an N95 Respirator
A fit check is required every single time you put on an N95. After positioning the respirator and adjusting the nose clip and straps, cup both hands over the front of the respirator and gently inhale. You should feel the respirator pull inward, collapsing slightly toward your face. Then exhale. The respirator should puff outward with air. If you feel air leaking around the edges during either breath, readjust the nose clip or reposition the straps and check again. Air escaping at the seal means unfiltered air is getting through.
Common leak points are along the nose bridge and under the chin. People with facial hair often struggle to get a reliable seal because hair prevents the respirator from sitting flush against the skin.
Step 3: Goggles or Face Shield
Eye protection goes on after the mask so it sits over the top edge of the mask or respirator, helping hold it in place and eliminating the gap between your eyes and your face covering. Place goggles or a face shield on your face and adjust until the fit feels secure. Goggles should seal around your eye sockets. A face shield should cover your forehead down to below your chin and wrap around the sides of your face.
If you wear prescription glasses, choose goggles designed to fit over them or use a face shield instead. Prescription lenses alone do not count as eye protection because they leave too much of the eye area exposed.
Step 4: Gloves
Gloves go on last for a specific reason: they need to overlap the cuffs of your gown. Select a size that fits your hand snugly without being so tight that they’re likely to tear. Pull each glove up and over the wrist of your gown sleeve so there’s no strip of bare skin between glove and gown. Non-sterile gloves are standard for isolation situations. If a glove tears or becomes heavily soiled during use, remove it, clean your hands, and put on a fresh one.
What You Need for Different Precaution Levels
Not every situation calls for the full set. The PPE you need depends on how an infection spreads:
- Contact precautions (infections spread by touch): gown and gloves.
- Droplet precautions (infections spread by coughs and sneezes at close range): surgical mask, added upon entering the room. A gown and gloves may also be needed depending on the level of contact expected.
- Airborne precautions (infections spread by tiny particles that float in the air): fit-tested N95 respirator or higher, plus eye protection, gown, and gloves.
Regardless of the precaution level, the donning order stays the same. You simply skip the pieces you don’t need.
Why the Removal Order Is Just as Important
By the time you’re ready to take PPE off, the outside surfaces are potentially contaminated. The removal sequence is essentially the reverse of donning, designed so you never touch a dirty outer surface with a bare hand.
Gloves come off first since they’re the most contaminated. Peel them off by grasping the outside of one glove near the wrist and pulling it inside out, then sliding a finger under the wrist of the second glove and peeling it off over the first. Clean your hands immediately. Next, remove the gown by unfastening the ties and pulling it away from your body, rolling the outside surface inward so the contaminated side folds in on itself. Clean your hands again. Remove your face shield or goggles by grasping the strap or earpieces at the back or sides (not the front surface). Finally, remove your mask or respirator by its ties or straps, pulling it away from your face without touching the front. Clean your hands one final time.
The key principles throughout removal: keep your hands away from your face, touch as few surfaces as possible, and perform hand hygiene between steps whenever your hands might have been contaminated.
Common Mistakes to Avoid
Putting gloves on before the gown leaves a gap at the wrist where the glove can’t overlap the sleeve. Placing eye protection before the mask means the mask edge won’t be secured under the goggles or shield. Skipping the respirator fit check turns an N95 into little more than a loose surgical mask. Touching the front of your mask to adjust it during use transfers contaminants to your hands or from your hands to your face.
If you need to adjust any piece of PPE while wearing it, clean your gloves with hand rub or change them afterward. And if any piece of equipment is visibly damaged, too small, or unable to form a proper seal, replace it before entering a contaminated area. PPE only works when every layer is intact and properly positioned.