Study guide · concept · Infection control & safety
PPE donning and doffing order for the CCMA
Put PPE on in this order: gown, mask or respirator, goggles or face shield, then gloves. Take it off in this order: gloves, goggles or face shield, gown, then the mask or respirator. A surgical mask comes off at the doorway, before you leave; only a respirator comes off after you've left the room.
- items in each sequence
- 4
- orders: on and off
- 2
- infection-control items of 150 scored
- 15
§01
Donning and doffing, side by side
Read each column top to bottom, then compare where the gloves sit.
| Step | Donning (putting on) | Doffing (taking off) |
|---|---|---|
| 1 | Gown | Gloves |
| 2 | Mask or respirator | Goggles or face shield |
| 3 | Goggles or face shield | Gown |
| 4 | Gloves | Mask (at the doorway) or respirator (after leaving the room) |
Hand hygiene comes before the first item goes on and after the last one comes off.
§02
Why doffing isn't donning reversed
If doffing were donning reversed, the mask would come off before the gown.
If you run the donning order backwards you get gloves, goggles, mask, gown. The real doffing order swaps the last two, so the gown comes off before the mask. That way your airway stays covered while you handle the most contaminated fabric.
The donning order has its own logic. The gown goes on first because everything else layers over it. The mask or respirator goes on before eye protection, so goggles sit over the straps and you can check the respirator's seal while your face is clear. Gloves go on last so their cuffs can be pulled over the gown's cuffs, closing the gap at the wrist.
§03
Taking it off without touching the outside
Treat every front surface as dirty. Handle ties, bands and insides.
Gloves
Use the glove-in-glove method. Pinch the outside of one glove at the wrist, peel it off and hold it in the gloved hand. Slide clean fingers under the cuff of the second glove and peel it over the first.
Goggles or face shield
Lift it away by the headband or ear pieces. The front faced the patient.
Gown
Release the ties, pull the gown away from your neck and shoulders touching only the inside, and roll it inside out into a bundle.
Mask or respirator
Grasp the bottom ties or elastic, then the top, and lift it off without touching the front. A surgical mask comes off at the doorway, still inside the room. A respirator stays on until you've left the room and closed the door.
§04
What each item is for
The precaution type tells you which items you need.
- Gloves
Hands. Worn under standard precautions whenever you may touch blood, body fluids, mucous membranes or non-intact skin.
- Gown
Clothing and forearms. Worn with gloves under contact precautions, for example for MRSA, VRE, C. diff or scabies.
- Surgical mask
Nose and mouth. Worn at close range (roughly 3–6 ft) under droplet precautions.
- Fit-tested N95 respirator
Filters airborne particles. Worn for TB, measles and varicella, with a negative-pressure room.
- Goggles or face shield
Eyes, when splashes or sprays are likely. A shield doesn't filter air.
The sequence stays the same when you wear only some of the items. Under contact precautions it's just gown then gloves going on, and gloves then gown coming off. Which disease calls for which items is covered on the contact, droplet and airborne precautions page.
§05
Variations on the sequence
Does a face shield come off at the same step as goggles?
Yes. Both are eye and face protection, and both are lifted off by the band or ear pieces.
Can the gown and gloves come off together?
Some facilities teach a method that peels both off in one inside-out bundle. On the exam, use the separate order: gloves first, gown third.
Why does the respirator go on before the goggles?
You need clear access to your face to seal-check the respirator. The goggles then sit over its straps.
§06
PPE sequence questions
6 questions. Pick an answer to see why it is right or wrong.
Say the whole sequence to yourself before you read the options, then find the step the stem is asking about.
What is the correct sequence for removing PPE?
Answer & explanation
Answer: D. Gloves, goggles, gown, mask
Gloves are the most contaminated item and come off first; goggles or face shield and gown follow, and the mask or respirator is removed last, outside the room, touching only the ties or straps. Removing the mask first or last-but-gloves means touching the face with contaminated gloves. Donning order is different (gown, mask, goggles, gloves), which is why the two are often confused.
- Starting with goggles means touching your face while the most contaminated item, your gloves, is still on.
- Removing the gown before the gloves spreads contamination from the gloves to your arms and clothing.
- Mask first exposes your airway early and brings dirty gloves up to your face.
- Correct: gloves, goggles or face shield, gown, then mask last, touching only the ties or straps.
When removing PPE after patient care, which item is taken off FIRST?
Answer & explanation
Answer: C. Gloves
PPE is removed gloves first because they are most contaminated, then goggles or face shield, then gown, with the mask removed last outside the room. Removing the mask first would expose the airway during the dirtiest steps.
- Goggles come second; removing them first means touching your face with contaminated gloves.
- The gown comes third, and pulling it off by the neck brings the dirty front toward you.
- Correct: gloves first, because they are the most contaminated item you are wearing.
- The mask comes off last, outside the room; first would expose your airway during the dirtiest steps.
Following the correct doffing sequence, which PPE item is removed LAST?
Answer & explanation
Answer: D. The respirator or mask
The mask or respirator comes off last, after gloves, eye protection and gown, so the airway stays protected longest. A surgical mask comes off at the doorway; only a respirator is removed after leaving the room (CDC).
- Gloves are the most contaminated item, so they come off first, not last.
- The gown comes off third, inside the room, after gloves and eye protection.
- Eye protection comes second, right after the gloves.
- Correct: face protection comes off last; a respirator is removed after you leave the room, a surgical mask at the doorway.
An MA is putting on PPE before entering a contact- and droplet-precautions room. Which item should be put on LAST?
Answer & explanation
Answer: D. Gloves
The donning order is gown, mask or respirator, goggles or face shield, then gloves last, so the gloves can be pulled over the gown cuffs. Goggles are the common wrong pick because they go on after the mask, but they still come before the gloves.
- The gown goes on first, not last.
- The mask or respirator is second, after the gown.
- Eye protection is third, before the gloves.
- Correct: gloves go on last and extend over the gown cuffs.
Leaving an airborne-precautions room, the MA has already removed the gloves and goggles. What should the MA do next?
Answer & explanation
Answer: A. Remove the gown, exit the room, then remove the respirator
After gloves and goggles, the gown comes off inside the room, and the respirator is removed last, only after the MA has left and closed the door. Taking the respirator off inside the room exposes the MA to airborne particles that are still in the air.
- Correct: gown inside, respirator last and outside the room.
- The respirator is never removed inside an airborne-precautions room.
- The contaminated gown should come off before leaving, not in the hallway.
- Removing the respirator at the bedside exposes the MA to airborne particles.
While removing goggles after patient care, an MA's bare hand touches the contaminated front of the goggles. The gown and mask are still on. What should the MA do next?
Answer & explanation
Answer: B. Perform hand hygiene right away, then continue with the gown and mask
CDC's PPE removal sequence says that if hands become contaminated at any point during removal, they should be washed or cleaned with alcohol-based hand rub immediately, before the next step. Waiting until all PPE is off is the tempting choice, but the contaminated hand would then touch the gown ties and mask straps and spread the contamination. Hand hygiene is performed again after the last item is removed.
- Waiting lets the contaminated hand carry germs to the gown ties, mask straps, and face.
- Correct: clean hands immediately whenever they become contaminated, then continue the sequence.
- Gloving over a contaminated hand traps the contamination and skips the required hand hygiene.
- All PPE except a respirator should come off before exiting; leaving in a gown spreads contamination.
That is the whole set. Open any card to re-read its explanation, or start over.