PPE Donning and Doffing: Correct Sequence Training for Care Staff

Personal protective equipment only works if it's put on and taken off in the right order. Skip a step, or touch the wrong surface while removing gloves, and PPE can become the thing that spreads infection rather than the thing that stops it. Care staff put on and take off gloves, aprons and masks dozens of times a day, which means small technique errors compound quickly across a shift — and across a whole care setting.

Why the sequence matters, not just the equipment

Most infection control training in care settings focuses on hand hygiene and when PPE is required, but the order of putting equipment on (donning) and taking it off (doffing) is just as important as wearing it at all. The entire point of PPE is to create a barrier between contaminated surfaces and the wearer's skin, clothing, and airway. If that barrier is breached during removal — for example, by touching the outside of a used glove with a bare hand — the equipment has failed at the exact moment it mattered most.

The donning sequence

Guidance used across UK and US infection control training (based on CDC and public health protocols widely adopted by NHS and independent care providers) sets out a consistent donning order: perform hand hygiene first, put on the apron or gown, then a fluid-resistant surgical mask or respirator, then eye protection if required, and gloves last. Gloves go on last because they're the layer most likely to become contaminated during care tasks, and putting them on first would mean touching every other item of PPE with hands that then go straight to a resident's skin or a shared surface.

The doffing sequence — where most mistakes happen

Removal is where technique errors are most common, because it happens at the point PPE is most likely to be contaminated. The recommended doffing order reverses much of the logic of donning, but with an extra layer of care: gloves are removed first, using a glove-to-glove, then skin-to-skin technique so the contaminated outer surface never touches bare skin. Hand hygiene follows immediately. The apron or gown comes off next, rolled inward so the contaminated outer surface stays contained, followed by eye protection (handled by the strap or arms, never the front), and finally the mask, removed from behind without touching the front panel. Hand hygiene should be performed again at the end of the sequence, and at any point during doffing where contamination is suspected.

Common errors that undo the protection

The most frequent mistakes staff make are touching the face or hair while still wearing PPE, removing a mask before gloves and aprons (exposing bare hands to a face that may carry pathogens from the task just completed), and reusing single-use items between residents. Rushing is the biggest single risk factor — doffing under time pressure, especially at the end of a busy round, is when corners get cut. Regular observed practice, not just a one-off demonstration, is what builds the muscle memory to get this right consistently.

When PPE is required in care settings

PPE use should be guided by the task and the resident's care plan rather than applied uniformly. Gloves and aprons are typically required for any contact with bodily fluids, wound care, continence care, and during outbreak management for conditions like norovirus or influenza. Fluid-resistant masks and eye protection are added when there's a risk of splashing, or during respiratory illness outbreaks. Providers should ensure PPE stock, sizing, and accessibility are part of routine infection prevention audits, not just staff training — the best technique in the world doesn't help if the right size of glove isn't available on the trolley.

Training, supervision and documentation expectations

CQC and HIQA both expect providers to be able to demonstrate that PPE competency isn't just taught once and forgotten. That means keeping records of who has completed donning and doffing training, when it was last refreshed, and evidence that competency has been observed in practice rather than only assessed through a written or e-learning module. Many providers build a short, practical PPE check into supervision sessions or spot audits, asking staff to demonstrate the full sequence rather than simply describe it. This matters during inspections: being able to explain the correct order verbally is not the same as showing consistent, confident technique under normal working conditions, and inspectors increasingly look for direct observation evidence rather than training certificates alone.

Frequently asked questions

How often should PPE technique be reassessed? Most providers include a practical PPE competency check as part of annual infection prevention and control refresher training, alongside spot-check observations during routine supervision.

Can the same apron be worn between different residents? No — aprons and gloves are single-use per care episode or per resident, and should be changed and disposed of between contacts, even if the task looks similar.

What's the most common technique error inspectors flag? Removing PPE in the wrong order, particularly taking off a mask before gloves, is one of the most frequently cited technique errors during infection control observations.

Getting the sequence right, every time, is a small discipline with an outsized impact on infection prevention and control compliance. Building it into regular practice — not just induction — keeps both residents and staff protected.