Personal protective equipment (PPE), putting on
Revised: August 21, 2023
Introduction
Standard and transmission-based precautions help prevent the spread of infection from
patient to patient, from patient to health care worker, and from health care worker to
patient. 12345 They also reduce the risk of infection in immunocompromised patients.
Central to the success of these precautions is the selection of the proper personal
protective equipment (PPE), such as gowns, gloves, masks, and eye protection as well as
adequate training of those who use them. 6
Selection of PPE should be based on the nature of the interaction with the patient and the
potential for exposure to infectious agents through contact with blood, body fluids, or
respiratory secretions. 5 Wear gloves to protect the hands. When you anticipate contact
with blood or body fluids, wear a fluid-resistant gown to protect the skin and clothing from
exposure to these fluids. Wear a mask with a face shield or a mask and goggles during
procedures that may generate a splash or spray of blood or body fluids. 7 Wearing a face
mask or fit-tested respirator mask is helpful in reducing the risk of transmission of
respiratory diseases between infected and noninfected persons. 8 Wearing a fit-tested
respirator is particularly helpful in preventing influenza and tuberculosis. 79
Knowledge of the proper order for putting on PPE is important for the prevention of
exposure to infectious agents. The improper use of equipment or lack of knowledge about
how to use PPE properly may increase the risk of exposure to infectious agents.
Clinical alert: When caring for a patient with known or suspected coronavirus disease
2019 (COVID-19), follow the latest recommendations from the Centers for Disease Control
and Prevention at https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-
recommendations.html.
Clinical alert: When caring for a patient with known or suspected Ebola virus disease,
follow the latest recommendations from the Centers for Disease Control and Prevention
at https://www.cdc.gov/vhf/ebola/clinicians/index.html.
Equipment
Required materials for standard and transmission-based precautions typically include PPE,
a cart or anteroom for storing equipment, and a door card or sign to alert staff members
and others entering the room that transmission-based precautions are in effect. PPE
includes:
• face shield
• fluid-resistant gown
• gloves
• goggles
• mask or respirator (with each staff member trained in its proper use)
• hair tie or hair cover (optional)
Preparation of Equipment
Inspect all equipment and supplies. If a product is expired, is defective, or has
compromised integrity, remove it from patient use, label it as expired or defective, and
report the expiration or defect as directed by your facility.
Remove the cover from the isolation cart, if necessary, and set up the work area. Check the
cart or anteroom to make sure that an adequate amount of the proper supplies are available
for the designated transmission-based precautions category.
Implementation
• Tie back your hair or wear a hair cover if your hair is long.
• Remove your watch (or push it well up on your arm) and rings (if required by your
facility). These actions help prevent the spread of microorganisms that may be hidden
under these adornments.
• Perform hand hygiene. 21011121314
• Pick up the fluid-resistant gown and allow it to unfold in front of you without
touching areas of your body that may be contaminated to minimize
microorganism transmission.
• Put on the gown and wrap it around the back of your uniform, making sure that it
overlaps and completely covers your uniform to prevent contact with the patient and
the patient's environment. 3515 Tie the strings or fasten the snaps or pressure-
sensitive tabs at the neck. Then, tie the waist strings.
• Place the mask snugly over your nose and mouth and below your chin. 515 Secure the
ear loops around your ears or tie the strings at the middle of the back of your head
and neck so that the mask won't slip off. If the mask has a metal nose strip, squeeze it
to fit your nose firmly but comfortably. 35 (See Putting on a face mask.) If you wear
eyeglasses, tuck the upper edge of the mask under the lower edge of the glasses to
minimize the likelihood of clouding your glasses.
EQUIPMENT
PUTTING ON A FACE MASK
Put on a face mask to avoid exposure to infectious agents and potentially infectious
blood or body fluids. 5 Position the mask to cover your nose and mouth and secure it
high enough to ensure stability. Tie the top strings at the back of your head above
the ears. Then tie the bottom strings at the base of your neck (as shown below).
Alternatively, if the face mask has ear loops, secure them around your ears. 36
Adjust the metal nose strip if the mask has one (as shown below). 36
• Choose eye protection according to your risk of exposure. Although goggles provide
eye protection, they don't protect the rest of the face from splashing of potentially
infectious substances. Wear a face shield for any procedures that may involve
spraying or splashing of respiratory secretions or other body fluids. 356
• Select gloves according to your hand size to make sure that they fit securely. Put on
the gloves and pull them over the cuffs of your gown to cover the edges of the gown's
sleeves. 15
Special Considerations
• If you must observe airborne precautions, wear an N95 or higher-level particulate
respirator approved by the Occupational Safety and Health Administration, rather
than a surgical mask. 358 (See the "Airborne precautions" procedure.) Employees who
wear respirators must undergo proper fit-testing initially and then periodically
thereafter, according to federal, state, and local regulations. 916 (See the "Fit testing
for an N95 mask" procedure.)
• If your respirator device is reusable, retain it for further personal use unless it's
contaminated or damaged or it fails to form a good seal. 16 Store it as directed by
your facility. Reuse of respiratory protection may consist of removing and putting on
the device again between patient encounters. To avoid a transmission risk, adhere to
stringent hand hygiene before and after handling the respiratory protection
device. 16
• Always perform hand hygiene before putting on gloves to avoid contaminating the
gloves with microorganisms from your hands. 21011121314
• Use gloves only once. 35 If a glove tears, remove it, perform hand hygiene, and put on
a new pair of gloves. 56
• Be aware that PPE loses its effectiveness when wet because moisture permits
organisms to seep through the material. Change masks and gowns as soon as
moisture is noticeable or according to the manufacturer's recommendations or your
facility's guidelines. 357
• Keep PPE and other isolation precaution supplies stocked so they're readily available
for those who must enter the patient's room. 5
Complications
Complications associated with improper PPE use may include:
• exposure to infectious organisms
• pathogen transmission.
Documentation
None necessary.
Related Procedures
• Hazardous drug preparation and handling
• Hazardous drug spill management
• Personal protective equipment (PPE), putting on, ambulatory care
• Personal protective equipment (PPE), putting on, home care
• Personal protective equipment (PPE), removal
• Personal protective equipment (PPE), removal, ambulatory care
References
(Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions)
1. The Joint Commission. (2023). Standard IC.02.01.01. Comprehensive accreditation
manual for hospitals. (Level VII)
2. Centers for Medicare and Medicaid Services. (2020). Condition of participation:
Infection control. 42 C.F.R. § 482.42.
3. Accreditation Commission for Health Care. (2021). Standard 07.01.10. Healthcare
Facilities Accreditation Program: Accreditation requirements for acute care
hospitals. (Level VII)
4. DNV GL-Healthcare USA, Inc. (2020). IC.1.SR.2. NIAHO® accreditation requirements,
interpretive guidelines and surveyor guidance – revision 20-1. (Level VII)
5. Siegel, J. D., et al. (2007, revised 2022). 2007 guideline for isolation precautions:
Preventing transmission of infectious agents in healthcare settings. Retrieved July
2023 from https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-
guidelines-H.pdf (Level VII)
6. Centers for Disease Control and Prevention. (n.d.). Personal protective equipment
(PPE): Coaching and training frontline health care professionals. Retrieved July 2023
from https://www.cdc.gov/infectioncontrol/pdf/strive/PPE103-508.pdf
7. Occupational Health and Safety Administration. (2019). Bloodborne pathogens,
standard number 1910.1030. Retrieved July 2023 from https://www.osha.gov/laws-
regs/regulations/standardnumber/1910/1910.1030 (Level VII)
8. Occupational Safety and Health Administration. (2019). Respiratory protection,
standard number 1910.134. Retrieved July 2023 from https://www.osha.gov/laws-
regs/regulations/standardnumber/1910/1910.134 (Level VII)
9. Centers for Disease Control and Prevention. (2005). Guidelines for preventing the
transmission of Mycobacterium tuberculosis in health-care settings, 2005. MMWR
Recommendations and Reports, 54(RR-17), 1–141. Retrieved July 2023
from https://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf (Level VII)
10. The Joint Commission. (2023). Standard NPSG.07.01.01. Comprehensive
accreditation manual for hospitals. (Level VII)
11. Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in
health-care settings: Recommendations of the Healthcare Infection Control Practices
Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task
Force. MMWR Recommendations and Reports, 51(RR-16), 1–45. Retrieved July 2023
from https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf (Level VII)
12. World Health Organization (WHO). (2009). WHO guidelines on hand hygiene in
health care: First global patient safety challenge, clean care is safer care. Retrieved
July 2023
from https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_
eng.pdf?sequence=1 (Level VII)
13. Accreditation Commission for Health Care. (2021). Standard 07.01.21. Healthcare
Facilities Accreditation Program: Accreditation requirements for acute care
hospitals. (Level VII)
14. DNV GL-Healthcare USA, Inc. (2020). IC.1.SR.1. NIAHO® accreditation requirements,
interpretive guidelines and surveyor guidance – revision 20-1. (Level VII)
15. Centers for Disease Control and Prevention. (n.d.). Sequence for donning personal
protective equipment (PPE). Retrieved July 2023
from https://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf
16. Rebmann, T., et al. (2009). APIC position paper: Extending the use and/or reusing
respiratory protection in healthcare settings during disasters. Retrieved July 2023
from http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-
PDFs/APIC_Position_Ext_the_Use_and_or_Reus_Resp_Prot_in_Hlthcare_Settings1209l
.pdf (Level VII)
Additional References
• Baloh, J., et al. (2019). Healthcare workers' strategies for doffing personal protective
equipment. Clinical Infectious Diseases, 69(Suppl. 3), S192–S198. Retrieved July 2023
from https://doi.org/10.1093/cid/ciz613 (Level VI)
• Phan, L. T., et al. (2019). Personal protective equipment doffing practices of
healthcare workers. Journal of Occupational and Environmental Hygiene, 16(8), 575–
581. Retrieved July 2023
from https://doi.org/10.1080/15459624.2019.1628350 (Level VI)
• World Health Organization. (2009). Glove use information leaflet. Retrieved July 2023
from https://www.who.int/publications/m/item/glove-use-information-leaflet-
(revised-august-2009) (Level VII)
Rating System for the Hierarchy of Evidence for Intervention/Treatment Questions
The following leveling system is from Evidence-Based Practice in Nursing and Healthcare: A Guide to
Best Practice (2nd ed.) by Bernadette Mazurek Melnyk and Ellen Fineout-Overholt.
Level I: Evidence from a systematic review or meta-analysis of all relevant randomized controlled tria
ls (RCTs)
Level II: Evidence obtained from well-designed RCTs
Level III: Evidence obtained from well-designed controlled trials without randomization
Level IV: Evidence from well-designed case-control and cohort studies
Level V: Evidence from systematic reviews of descriptive and qualitative studies
Level VI: Evidence from single descriptive or qualitative studies
Level VII: Evidence from the opinion of authorities and/or reports of expert committees
Modified from Guyatt, G. & Rennie, D. (2002). Users' Guides to the Medical Literature. Chicago, IL:
American Medical Association; Harris, R.P., Hefland, M., Woolf, S.H., Lohr, K.N., Mulrow, C.D., Teutsch, S.M.,
et al. (2001). Current Methods of the U.S. Preventive Services Task Force: A Review of the Process.
American Journal of Preventive Medicine, 20, 21-35.
