Sequence for Putting On and Removing PPE Checklist

• Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• The type of PPE used will vary based on the level of precautions required, such as standard and contact, droplet or airborne infection isolation precautions. The procedure for putting on and removing PPE should be tailored to the specific type of PPE.

1. GOWN

• •Fully cover torso from neck to knees, arms to end of wrists, and wrap around the back

  ✔

  ❌

  N/A

• •Fasten in back of neck and waist

  ✔

  ❌

  N/A

2. MASK OR RESPIRATOR

• • Secure ties or elastic bands at middle of head and neck

  ✔

  ❌

  N/A

• • Fit flexible band to nose bridge

  ✔

  ❌

  N/A

• • Fit snug to face and below chin

  ✔

  ❌

  N/A

• • Fit-check respirator

  ✔

  ❌

  N/A

3. GOGGLES OR FACE SHIELD

• • Place over face and eyes and adjust to fit

  Yes

  No

  N/A

4. GLOVES

• • Extend to cover wrist of isolation gown

  Yes

  No

  N/A

USE SAFE WORK PRACTICES TO PROTECT YOURSELF AND LIMIT THE SPREAD OF CONTAMINATION

• • Keep hands away from face

  ✔

  ❌

  N/A

• • Limit surfaces touched

  ✔

  ❌

  N/A

• • Change gloves when torn or heavily contaminated

  ✔

  ❌

  N/A

• • Perform hand hygiene

  ✔

  ❌

  N/A

• EXAMPLE 1
  
  There are a variety of ways to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially infectious materials. Here is one example. Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after leaving the patient room and closing the door. Remove PPE in the following sequence:

EXAMPLE 1

1. GLOVES

• • Outside of gloves are contaminated!

  ✔

  ❌

  N/A

• • If your hands get contaminated during glove removal, immediately wash your hands or use an alcohol-based hand sanitizer

  ✔

  ❌

  N/A

• • Using a gloved hand, grasp the palm area of the other gloved hand and peel off first glove

  ✔

  ❌

  N/A

• • Hold removed glove in gloved hand

  ✔

  ❌

  N/A

• • Slide fingers of ungloved hand under remaining glove at wrist and peel off second glove over first glove

  ✔

  ❌

  N/A

• • Discard gloves in a waste container

  ✔

  ❌

  N/A

2. GOGGLES OR FACE SHIELD

• • Outside of goggles or face shield are contaminated!

  ✔

  ❌

  N/A

• • If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer

  ✔

  ❌

  N/A

• • Remove goggles or face shield from the back by lifting head band or ear pieces

  ✔

  ❌

  N/A

• • If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste container

  ✔

  ❌

  N/A

3. GOWN

• • Gown front and sleeves are contaminated!

  ✔

  ❌

  N/A

• • If your hands get contaminated during gown removal, immediately wash your hands or use an alcohol-based hand sanitizer

  ✔

  ❌

  N/A

• • Unfasten gown ties, taking care that sleeves don’t contact your body when reaching for ties

  ✔

  ❌

  N/A

• • Pull gown away from neck and shoulders, touching inside of gown only

  ✔

  ❌

  N/A

• • Turn gown inside out

  ✔

  ❌

  N/A

• • Fold or roll into a bundle and discard in a waste container

  ✔

  ❌

  N/A

4. MASK OR RESPIRATOR

• • Front of mask/respirator is contaminated — DO NOT TOUCH!

  ✔

  ❌

  N/A

• • If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer

  ✔

  ❌

  N/A

• • Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front

  ✔

  ❌

  N/A

• • Discard in a waste container

  ✔

  ❌

  N/A

5. WASH HANDS OR USE AN ALCOHOL-BASED HAND SANITIZER IMMEDIATELY AFTER REMOVING ALL PPE

• 5. Wash hands or use an alcohol-based hand sanitizer immediately after removing all ppe

  ✔

  ❌

  N/A

• PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS
  BECOME CONTAMINATED AND IMMEDIATELY AFTER
  REMOVING ALL PPE

EXAMPLE 2

• Here is another way to safely remove PPE without contaminating your clothing, skin, or mucous membranes with potentially infectious materials. Remove all PPE before exiting the patient room except a respirator, if worn. Remove the respirator after
  leaving the patient room and closing the door. Remove PPE in the following sequence:

1. GOWN AND GLOVES

• • Gown front and sleeves and the outside of gloves are contaminated!

  ✔

  ❌

  N/A

• • If your hands get contaminated during gown or glove removal, immediately wash your hands or use an alcohol-based hand immediately wash your hands or use an alcohol-based hand

  ✔

  ❌

  N/A

• • Grasp the gown in the front and pull away from your body so that the ties break, touching outside of gown only with gloved hands

  ✔

  ❌

  N/A

• • While removing the gown, fold or roll the gown inside-out into a bundle

  ✔

  ❌

  N/A

• • As you are removing the gown, peel off your gloves at the same time, only touching the inside of the gloves and gown with your bare hands. Place the gown and gloves into a waste container

  ✔

  ❌

  N/A

2. GOGGLES OR FACE SHIELD

• • Outside of goggles or face shield are contaminated!

  ✔

  ❌

  N/A

• • If your hands get contaminated during goggle or face shield removal, immediately wash your hands or use an alcohol-based hand sanitizer

  ✔

  ❌

  N/A

• • Remove goggles or face shield from the back by lifting head band and without touching the front of the goggles or face shield

  ✔

  ❌

  N/A

• • If the item is reusable, place in designated receptacle for reprocessing. Otherwise, discard in a waste containe

  ✔

  ❌

  N/A

3. MASK OR RESPIRATOR

• • Front of mask/respirator is contaminated — DO NOT TOUCH!

  ✔

  ❌

  N/A

• • If your hands get contaminated during mask/respirator removal, immediately wash your hands or use an alcohol-based hand sanitizer

  ✔

  ❌

  N/A

• • Grasp bottom ties or elastics of the mask/respirator, then the ones at the top, and remove without touching the front

  ✔

  ❌

  N/A

• • Discard in a waste container

  ✔

  ❌

  N/A

4. WASH HANDS OR USE AN ALCOHOL-BASED HAND SANITIZER IMMEDIATELY AFTER REMOVING ALL PPE

• 4. Wash hands or use an alcohol-based hand sanitizer immediately after removing all ppe

  ✔

  ❌

  N/A

• PERFORM HAND HYGIENE BETWEEN STEPS IF HANDS
  BECOME CONTAMINATED AND IMMEDIATELY AFTER
  REMOVING ALL PPE

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