Donning means putting on protective equipment, and doffing means taking it off. The terms come from old English (“do on” and “do off”) and are used most often in healthcare and industrial workplaces where personal protective equipment (PPE) is required. While the words sound simple, each process follows a specific sequence designed to keep the wearer safe from contamination or hazardous exposure.
Why the Order Matters
Donning and doffing aren’t just about getting dressed and undressed. The sequence in which you put on and remove each piece of equipment directly affects whether the gear actually protects you. During doffing especially, the outside surfaces of your gloves, gown, and mask may be contaminated. Touching them in the wrong order, or touching your face or clothing in the process, can transfer pathogens or chemicals to your skin.
A study of healthcare workers found an average of 2.2 contamination incidents per person during a single doffing session. The riskiest steps were removing respirators (79% of participants made an error), removing shoe covers (65%), and removing hoods (41%). Donning errors were less frequent but still common, with outer gloves, respirators, and hoods each causing mistakes in about 20–27% of participants.
The Standard Donning Sequence
The CDC recommends putting on PPE in this order:
- Gown first. It should cover your torso from neck to knees and your arms to the wrists, wrapping around your back. Fasten it at the neck and waist.
- Mask or respirator second. Secure the ties or elastic bands at the middle of your head and neck. If you’re wearing an N95 respirator, mold the flexible band over your nose bridge and do a seal check: inhale and exhale forcefully a few times. The respirator should collapse slightly when you breathe in and expand when you breathe out. If you feel air leaking around the edges, readjust before continuing.
- Goggles or face shield third. Place over your face and eyes and adjust for a snug fit.
- Gloves last. Pull them on so they extend over the wrists of your gown, leaving no gap of exposed skin.
This bottom-to-top, inside-to-outside logic ensures that each subsequent layer overlaps the one beneath it, closing off entry points.
The Standard Doffing Sequence
Removal reverses the priority: the most contaminated items come off first. The CDC-recommended order for standard isolation precautions is gloves, then gown, then mask or respirator, with hand hygiene performed after gloves and gown are removed and again after the mask comes off.
The reasoning is straightforward. Your gloves have touched the most contaminated surfaces, so they go first. The gown’s outer surface is the next most exposed area. Your mask or respirator, sitting close to your face, is removed last and only after your hands are clean. Each piece should be peeled away from your body, not pulled over your face or snapped off. Slow, deliberate movements reduce the chance of flinging droplets or touching contaminated surfaces.
For higher-risk situations involving diseases like Ebola, the process becomes much more elaborate, potentially involving boot covers, hoods, powered air-purifying respirators, and multiple layers of gloves, each removed in a precise order with hand sanitizing between every step.
Common Doffing Mistakes
Researchers who observed healthcare workers across multiple hospitals identified 19 recurring errors during doffing. Many were small, reflexive movements that people didn’t realize they were making:
- Snapping or whipping gloves off instead of peeling them away slowly. A glove that recoils sharply can fling contaminated material.
- Touching the outside of inner gloves with the outer pair during removal.
- Pulling a hood or respirator off from the front instead of from the back, bringing contaminated surfaces across the face.
- Incomplete hand hygiene between steps. Workers consistently missed their wrists, thumbs, and the spaces between fingers. Many also shook their hands to dry rather than rubbing until dry.
- Touching boot covers excessively or whipping them off, which can spread contamination from the floor to the hands.
- Exposed skin during gown removal. With coverall-style gowns, the lower back sometimes became exposed as workers struggled to pull the garment down.
No site in the study achieved consistent, complete hand coverage during the sanitizing steps. This is notable because hand hygiene between removals is the primary safety net that prevents contamination from carrying over from one step to the next.
The Trained Observer System
For high-consequence infections, the CDC requires a trained observer to supervise every step of both donning and doffing. This person reads each step aloud from a checklist, visually confirms it was done correctly, and documents the process. If the worker makes an error, the observer provides immediate correction.
The observer’s role has specific boundaries. They coach and monitor but do not physically assist during doffing, since that would mean touching potentially contaminated equipment. The observer must also wear PPE because they’re standing in the removal area during the process. In some cases, a separate “doffing buddy” may help with specific steps like disconnecting a powered respirator.
Even outside high-risk infectious disease settings, having a second person watch the process catches errors that the wearer simply cannot see, like a gap between glove and gown or a hood that wasn’t fully sealed.
Where Donning and Doffing Happen
In healthcare facilities, the physical space is typically divided into zones. The hot zone is the contaminated area (the patient room, for example). The warm zone is the transition space where doffing takes place. The cold zone is the clean area free of contamination, used for planning and staging. PPE should always come off before entering any non-clinical space, including restrooms, break rooms, and offices.
The layout of these spaces matters more than you might expect. A study of hospital doffing areas found that trash cans were generally placed within five feet of patient room doors, but sinks were often 15 feet or more away. That distance creates a gap in the process: workers need to sanitize their hands multiple times during doffing, but the nearest sink may be across the hallway. Wall-mounted hand sanitizer dispensers in the immediate doffing area help bridge this gap, though healthcare workers in the study noted the need for better-designed PPE stations overall.
Workplace Training Requirements
OSHA requires employers to train every worker who uses PPE on how to properly don, doff, adjust, and wear their equipment. Workers must also learn when PPE is necessary, what type to use, the limitations of their gear, and how to care for and dispose of it. Before an employee can begin work requiring PPE, they need to demonstrate that they understand the training and can actually perform the procedures correctly.
Retraining is required when workplace conditions change, when new types of PPE are introduced, or when a worker shows gaps in their knowledge or technique. This isn’t a one-time orientation topic. Doffing in particular is a motor skill that degrades without practice, and the research on contamination rates suggests that even experienced healthcare workers make frequent errors without ongoing reinforcement.