Personal protective equipment (PPE), removal

Revised: August 21, 2023

Introduction

The use of standard and transmission-based precautions helps prevent the spread of
infection from patient to patient, patient to health care worker, and health care worker to
patient. 12345 These precautions also help reduce the risk of infection in
immunocompromised patients. The success of these precautions depends on selecting the
proper personal protective equipment (PPE)—such as gowns, gloves, masks, and
protective eyewear—and providing adequate training for those who use PPE, including
how to remove PPE properly and in the correct sequence to avoid contamination. 6

Clinical alert: When caring for a patient with known or suspected coronavirus disease
2019 (COVID-19), refer to 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,
refer to the latest recommendations from the Centers for Disease Control and Prevention
at https://www.cdc.gov/vhf/ebola/clinicians/index.html.

Equipment
• Receptacles for gown and other PPE
Implementation
• After completing patient care, prepare to leave the room by collecting items that
require removal.
• Remember that the outside surfaces of your goggles or face shield, mask or
respirator, gloves, and barrier clothes (such as a gown) are contaminated. 35
• Except for a respirator mask, remove all PPE at the patient's doorway or in the
anteroom. Remove a respirator mask after leaving the patient's room and closing the
door. 357
• Remove your gloves using the appropriate technique. (See Removing contaminated
gloves.) Don't touch any of your skin surfaces with the outside of either glove. 8
• Discard your gloves in an appropriate receptacle. 79

EQUIPMENT
REMOVING CONTAMINATED GLOVES

Proper removal techniques are essential to help prevent the spread of pathogens
from your gloves to your skin surfaces. Follow these steps carefully to remove your
contaminated gloves properly. 5

• Grasp the outside of one glove with your opposite gloved hand and peel it off,
turning the glove inside out as you pull it off (as shown below). Hold the
removed glove in your remaining gloved hand. 7

• Slide two fingers of your ungloved hand under the remaining glove at the
wrist, taking care not to touch the outer surface of the glove (as shown
below). 7
• Peel off the glove over the first removed glove, containing one glove inside
the other (as shown below). 7
• Discard your gloves in an appropriate receptacle. 79
• Perform hand hygiene. 21011121314
• To remove your gown, follow these steps:
o Untie the neck straps and then the waist ties. 8
o Pull the gown away from your neck and shoulders, touching only the inside of
the gown (as shown below). Turn the gown inside out as you remove it,
folding it or rolling it into a bundle to contain pathogens. 8
o Discard the gown in an appropriate receptacle. (See Removing your gown and
gloves together.) 79
o Perform hand hygiene. 21011121314
• To remove your goggles or face shield, follow these steps:
o Grasp the ear pieces or headband, and remove the goggles or face shield
carefully. 8
o Place the equipment in the appropriate receptacle for reprocessing or discard
it in an appropriate receptacle. 56789
• To remove your mask or respirator, follow these steps:
o Grasp the bottom tie or elastic and lift it over your head. 8
o Then grasp the top tie or elastic, and carefully remove the mask or respirator.
Don't touch the front of the mask to prevent contamination. 8
o Discard the mask or respirator in an appropriate receptacle. 79
• Perform hand hygiene immediately. 21011121314
REMOVING YOUR GOWN AND GLOVES TOGETHER

The Centers for Disease Control and Prevention discusses an alternative method for
removing your gown and gloves. For this method, you'll use a disposable gown and
remove the gown and gloves together. 8 Follow these steps to remove your gown and
gloves together:

• With your gloved hands, grasp the gown in the front.

• Pull the gown away from your body so that the ties break.
• While removing the gown, fold or roll the gown inside out into a bundle.
• As you remove the gown, peel off your gloves at the same time. Touch only the
inside of your gloves and gown with your bare hands.
• Discard the gown and gloves in an appropriate receptacle. 79
• Perform hand hygiene immediately. 21011121314

Special Considerations
• Use gloves only once. Discard them in the appropriate trash container before leaving
a contaminated area. 3579
• If your respiratory protection device is reusable, retain it for further personal use
unless it's contaminated, it's damaged, or it fails to form a good seal. 15 Store it as
directed by your facility. Reuse of respiratory protection may consist of removing
and reapplying the device between patient encounters. To avoid a transmission
risk, adhere to stringent hand hygiene before and after handling the respiratory
protection device. 15
• Be aware that masks and gowns lose their effectiveness when wet, because moisture
permits organisms to seep through the material. Change your mask or gown as soon
as it becomes moist or according to the manufacturer's recommendations or your
facility's guidelines. 359
Complications

Complications associated with improper PPE use may include:

• exposure to infectious organisms

• pathogen transmission.
Documentation

None necessary.
 Related Procedures
• Personal protective equipment (PPE), putting on
• Personal protective equipment (PPE), putting on, ambulatory care
• 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. Centers for Disease Control and Prevention. (n.d.). Sequence for donning personal
protective equipment (PPE); Sequence for removing personal protective equipment
(PPE). Retrieved July 2023
from https://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf
8. Centers for Disease Control and Prevention. (n.d.). Sequence for putting on personal
protective equipment (PPE); How to safely remove personal protective equipment
(PPE). Retrieved July 2023 from https://www.cdc.gov/hai/pdfs/ppe/PPE-
Sequence.pdf
 9. Occupational Safety and Health 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)
10. The Joint Commission. (2023). Standard NPSG.07.01.01. Comprehensive
accreditation manual for hospitals. (Level VII)
11. 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)
12. 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)
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. 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
• World Health Organization. (2009). Glove use information leaflet. Retrieved July 2023
from https://cdn.who.int/media/docs/default-source/integrated-health-services-
(ihs)/infection-prevention-and-control/hand-hygiene/tools/glove-use-information-
leaflet.pdf?sfvrsn=13670aa_10&download=true (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.