The four items of PPE (personal protective equipment) you should choose are gloves, a gown, a mask or respirator, and eye protection such as goggles or a face shield. These are the four components outlined in standard precautions by the CDC for protecting against infectious materials in healthcare settings. Which combination you actually wear for a given task depends on the type of exposure you expect.
The Four Standard PPE Items
Each of the four items protects a different route of exposure. Together, they form a barrier between you and potentially infectious blood, body fluids, secretions, and contaminated surfaces.
- Gloves protect your hands from direct contact with infectious material or contaminated surfaces. Non-sterile gloves are standard for most isolation and routine care tasks.
- Gown covers your torso from neck to knees and your arms to the wrists, shielding your skin and clothing from splashes or contact with contaminated material.
- Mask or respirator protects your nose and mouth. A surgical mask blocks large droplets, splashes, and sprays. An N95 respirator provides a much tighter facial seal and filters very small airborne particles, making it necessary when airborne transmission is a concern.
- Eye protection (goggles or a face shield) covers your eyes from splashes, sprays, and droplets. A face shield also offers some protection to the rest of your face.
How to Decide Which Items You Need
You don’t always need all four at once. Selection depends on the risk of the task you’re about to perform. The key question is: what kind of exposure is likely?
If you’re drawing blood or starting an IV, gloves alone may be enough because the main risk is hand contact with blood. If you’re caring for someone with a wound that might splash, you’d add a mask and eye protection. For tasks involving large volumes of body fluid or a patient in isolation, all four items are appropriate. The principle is straightforward: match PPE to the anticipated splash, spray, droplet, or contact exposure.
Combining PPE with good hand hygiene makes a real difference. Research on infection control measures found that wearing a surgical mask together with hand hygiene reduces transmission risk by 60% to 64% compared to using no protection at all.
Surgical Mask vs. N95 Respirator
This is one of the most common selection decisions. A surgical mask is designed to block large-particle droplets and splashes from reaching your mouth and nose. It does not seal tightly to your face and does not filter very small airborne particles effectively.
An N95 respirator, by contrast, fits closely against the skin and filters airborne particles with high efficiency. You need a fit test to confirm it seals properly on your face. Choose an N95 (or equivalent respirator) when caring for patients with airborne infections like tuberculosis or during procedures that generate aerosols. For standard droplet and contact precautions, a surgical mask is sufficient.
Choosing the Right Gloves
Nitrile and latex are the two most common glove materials. Nitrile gloves have high puncture resistance and excellent chemical resistance, making them effective against oils, fats, and a wide range of chemicals. Latex gloves offer moderate puncture resistance and limited chemical protection. Nitrile is also the safer default choice because latex allergies are common. Select a size that fits snugly, and when wearing a gown, extend the glove cuff over the gown’s wrist to eliminate gaps in coverage.
Putting PPE On (Donning)
The order matters. Put items on in this sequence:
- Gown first. Cover your torso fully from neck to knees, wrap it around your back, and fasten at the neck and waist.
- Mask or respirator second. Secure the ties or elastic bands at the middle of your head and neck. Mold the flexible nose bridge to fit, and make sure it sits snug against your face and below your chin. If using a respirator, perform a fit check.
- Goggles or face shield third. Place on your face and adjust for a comfortable, secure fit.
- Gloves last. Pull them on and extend the cuffs over the wrists of your gown so no skin is exposed.
Taking PPE Off (Doffing)
Removal is where contamination is most likely to happen. The outside surfaces of your PPE are considered dirty, so the goal is to peel each item away without touching those outer surfaces with bare skin. Remove items in this order:
- Gloves first. Grasp the outside of one glove with the opposite gloved hand and peel it off. Hold the removed glove in your still-gloved hand. Slide your bare fingers under the remaining glove at the wrist and peel it off, turning it inside out over the first glove. Discard both.
- Goggles or face shield second. Handle them only by the headband or ear pieces (the “clean” parts). Place in a reprocessing bin or waste container.
- Gown third. Unfasten the neck tie, then the waist tie. Pull the gown away from each shoulder toward the same hand using a peeling motion so it turns inside out. Hold it away from your body, roll it into a bundle, and discard.
- Mask or respirator last. Do not touch the front of the mask. Grasp only the bottom ties or elastics first, then the top ones, and lift it away from your face. Discard immediately.
Perform hand hygiene immediately after all PPE is removed. This final step is just as critical as the equipment itself.
PPE in Industrial and Construction Settings
Outside of healthcare, the “four items” question comes up differently. OSHA requires employers to provide PPE whenever workplace hazards can cause injury through absorption, inhalation, or physical contact. A typical basic industrial PPE kit includes a hard hat for head protection, safety glasses or goggles for eye protection, gloves for hand protection, and steel-toed boots or safety shoes for foot protection. Some workplaces swap in hearing protection (earplugs or earmuffs) or respirators depending on the specific hazards present.
For eye protection in industrial settings, look for the Z87 marking on safety glasses, which indicates compliance with the current impact resistance standard. A Z87+ marking means the eyewear meets high-impact certification, suitable for environments with flying debris or projectiles.