Published online: 2020-05-21
THIEME
Point of Technique 61
A Practical Guide to a Safe Sequence of Donning and
Doffing of Personal Protective Equipment in Relation
to COVID-19
Vijay Samuel Richard1 Muralidhar Kanchi2
1 Consultant, Hospital Infection Control Address for correspondence Muralidhar Kanchi, MD, FIACTA, FICA,
2 Department of Cardiac Anaesthesia and Critical Care, Narayana MBA, FASE, Department of Anaesthesia and Critical Care, Narayana
Institute of Cardiac Sciences, Bangalore, Karnataka, India Institute of Cardiac Sciences, Narayana Health City, #258/A,
Bommasandra Industrial Area, Anekal Taluk, Bangalore 560 099,
Karnataka, India (e-mail: muralidhar.kanchi.dr@narayanahealth.org).
J Card Crit Care:2020;4:61–63
Abstract When caring for patients with suspected or confirmed COVID-19 (coronavirus disease
2019), especially when involved in procedures that generate aerosol, personal pro-
tective equipment (PPE) with full-body coverage is recommended. The Centers for
Disease Control and Prevention emphasizes and recommends the following princi-
ples with regard to donning and doffing of PPE: (1) training and education (rigorous
Keywords and repeated training of the health care workers [HCWs]), (2) all HCWs must exhibit
►►doffing competency in the PPE donning and doffing, and (3) PPE doffing should be done in a
►►donning manner that prevents self-contamination or self-inoculation with contaminated PPE or
►►PPE hands (remove the most contaminated PPE items first, perform hand hygiene at each
►►COVID-19 stage of doffing, and discard disposable items in containers for biomedical waste).
General Principles stage of doffing, and discard disposable items in containers
for biomedical waste).
When caring for patients with suspected or confirmed
COVID-19 (coronavirus disease 2019), especially when
involved in procedures that generate aerosol, personal pro- Procedure for Donning the PPE
tective equipment (PPE) with full-body coverage is recom- The procedure for donning the PPE is as follows: (1) wear the
mended. The Centers for Disease Control and Prevention PPE in a designated area before entering the patient care area,
emphasizes and recommends the following principles with (2) undertake the procedure of putting on PPE under the
regard to donning and doffing of PPE: (1) training and educa- guidance and supervision of a trained observer (colleague),
tion (rigorous and repeated training of the health care work- (3) remove all personal items such as watch, jewelry, pen, cell
ers [HCWs]), (2) all HCWs must exhibit competency in the phone, and so on, (4) use the restroom and drink sufficient
PPE donning and doffing, and (3) PPE doffing should be done water before starting to wear the PPE, (5) before donning,
in a manner that prevents self-contamination or self-inoc- ensure that all required PPE are available, and (6) follow the
ulation with contaminated PPE or hands (remove the most steps as shown in ►Fig. 1.
contaminated PPE items first, perform hand hygiene at each
published online DOI https://doi.org/ ©2020 Official Publication of The
21 May 2020 10.1055/s-0040-1712804 Simulation Society (TSS), accredited
ISSN 2457-0206. by International Society of
Cardiovascular Ultrasound (ISCU).
62 Donning and Doffing of Personal Protective Equipment: Guidelines Richard,Kanchi
Fig. 1 Donning of personal protective equipment (PPE).
Journal of Cardiac Critical Care TSS Vol. 4 No. 1/2020
Donning and Doffing of Personal Protective Equipment: Guidelines Richard,Kanchi 63
Fig. 2 Doffing of personal protective equipment (PPE).
Procedure for Doffing of PPE (3) ensure that PPE is discarded immediately into the appropri-
ate bin, and (4) follow the steps shown in ►Fig. 2.
The procedure for doffing of PPE is as follows: (1) doffing is done
in a designated area, (2) always perform doffing under the guid- Conflict of Interest
ance and supervision of a trained observer or colleague, and None.
Journal of Cardiac Critical Care TSS Vol. 4 No. 1/2020
