A Step By Step Guide To Safely Removing Personal Protective Equipment According To CDC Guidelines

Proper use of personal protective equipment (PPE) is only effective if it is removed correctly. In healthcare, laboratory, and high-risk environments, the risk of self-contamination during PPE removal remains one of the most common sources of exposure to infectious agents. The Centers for Disease Control and Prevention (CDC) emphasize that safe doffing—removing PPE in a specific sequence—is as critical as wearing it. Incorrect removal can transfer pathogens from contaminated surfaces to skin, clothing, or mucous membranes, potentially leading to infection.

This guide outlines the CDC-recommended procedure for removing PPE in the correct order, with detailed steps, practical tips, and real-world context to ensure safety and compliance.

Why Proper PPE Removal Matters

PPE—including gloves, gowns, masks, and eye protection—is designed to create a barrier between the wearer and hazardous materials. However, once used, the outer surfaces become contaminated. Touching these surfaces during removal without proper technique increases the risk of transferring pathogens to clean areas of the body or environment.

The CDC reports that up to 40% of healthcare worker exposures occur during the doffing process, often due to rushed removal, lack of supervision, or skipping hand hygiene. This statistic underscores the importance of strict adherence to established protocols.

“Safe PPE removal isn’t just about following steps—it’s about mindset. Every movement must be deliberate and contamination-aware.” — Dr. Linda Thomas, Infection Prevention Specialist, CDC

Step-by-Step Guide to Safe PPE Removal

The CDC recommends a specific sequence for removing PPE to minimize contact with contaminated surfaces. The order is crucial: gloves first, then gown, followed by eye protection, and finally the respirator or mask. Hand hygiene must be performed immediately after each step and at the end of the process.

1. Remove Gloves
   Grasp the outside of one glove with the opposite gloved hand, pulling it off inside out. Hold the removed glove in the still-gloved hand. Then, slide a finger under the remaining glove at the wrist, avoiding skin contact, and peel it off over the first glove. Dispose of gloves in a designated waste container.
   
   
   Tip: Never touch the outside of the glove with bare skin. If you accidentally do, perform hand hygiene immediately.
2. Perform Hand Hygiene
   After glove removal, wash hands thoroughly with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer (at least 60% alcohol). This step removes any pathogens transferred during glove removal.
3. Remove Gown
   Unfasten ties at the neck and back. Pull the gown away from the shoulders, turning the contaminated outer surface inward as you peel it off. Roll or fold it into a bundle and discard in a biohazard or designated waste container. Avoid shaking the gown to prevent aerosolizing contaminants.
4. Perform Hand Hygiene Again
   Clean hands again before touching other facial PPE. Even brief contact with the gown’s ties or closures can transfer microorganisms.
5. Remove Eye Protection (Goggles or Face Shield)
   Handle only the earpieces or straps. Lift the device away from the face without touching the front, which is likely contaminated. Place reusable eye protection in a designated cleaning container; dispose of single-use items appropriately.
6. Remove Mask or Respirator
   For surgical masks: grasp the ear loops or ties and pull forward and away from the face without touching the front.
   For N95 respirators: hold only the bottom strap, then the top strap, pulling them forward and lifting the respirator off without touching the front. Discard immediately in a closed waste container.
7. Final Hand Hygiene
   Wash hands thoroughly once more after all PPE has been removed. This final step ensures no residual contamination remains.

Do’s and Don’ts of PPE Doffing

Do’s	Don’ts
Wash hands before and after each PPE removal step	Touch the outer surface of gloves, mask, or gown with bare hands
Remove PPE in a designated clean area, away from patient zones	Rush through the removal process
Use mirrors or checklists to verify technique	Adjust PPE once worn or reuse disposable items
Have a trained observer supervise high-risk doffing (e.g., Ebola-level PPE)	Walk through clinical areas while partially undressed in PPE
Fold contaminated gowns inward to contain pathogens	Hang used PPE on hooks or railings

Real-World Example: A Nurse’s Close Call

In early 2020, a nurse working in a surge ICU treating COVID-19 patients removed her N95 respirator before taking off her face shield. As she lifted the mask by its straps, her hand briefly brushed the front of the respirator—a heavily contaminated surface. She then touched her face while adjusting her glasses.

Within days, she developed symptoms and tested positive for SARS-CoV-2. An internal review concluded that the infection likely occurred during improper PPE removal. This case led the hospital to implement mandatory supervised doffing stations and daily refresher training.

This incident illustrates how easily protocol deviations can lead to exposure—even among experienced professionals.

Tip: Always remove respiratory protection last, after eye protection. The face is highly vulnerable; keep it shielded until the very end.

Essential Checklist for Safe PPE Removal

• Ensure you are in a designated doffing area, free from traffic and contamination.
• Verify hand hygiene supplies are within reach.
• Inspect gloves for tears before beginning removal.
• Remove gloves using the pinch-and-peel method, never pulling from the fingertips.
• Wash hands after glove removal.
• Unfasten gown ties without leaning forward; avoid contact with sleeves.
• Peel gown off from the inside, rolling it into a compact bundle.
• Wash hands again before touching eye protection.
• Handle goggles or face shield by the sides or straps only.
• Remove mask or respirator by the straps—never the front.
• Dispose of all used PPE in appropriate containers.
• Perform final hand hygiene using soap and water or sanitizer.
• Change into clean clothing if necessary before leaving the area.

Frequently Asked Questions

Can I remove my mask before taking off my gown?

No. The CDC specifies that the mask or respirator should be the last piece of PPE removed, after gloves, gown, and eye protection. Removing the mask early exposes your nose and mouth to potential contamination from handling other PPE.

What should I do if I accidentally touch a contaminated surface during removal?

Stop immediately and perform hand hygiene before continuing. If the exposure involves mucous membranes (e.g., touching your face), report the incident to your supervisor and follow institutional exposure protocols, which may include monitoring or testing.

Is hand sanitizer acceptable instead of handwashing during PPE removal?

Yes, if hands are not visibly soiled. Alcohol-based hand sanitizer (60–95% alcohol) is effective for decontamination. However, when hands are visibly dirty or contaminated with blood or bodily fluids, washing with soap and water for at least 20 seconds is required.

Final Steps for Lasting Safety

Safely removing PPE is not a routine task—it’s a critical defense against infection. Mastery comes from repetition, awareness, and respect for the risks involved. Institutions should provide regular training, visual aids, and peer observation to reinforce best practices.

Whether you're a healthcare provider, lab technician, or emergency responder, your protection depends not only on what you wear but on how you take it off. By following CDC guidelines precisely, you protect not only yourself but also your colleagues, patients, and community.

🚀 Take action today: Review your workplace’s PPE protocol, practice the doffing sequence, and encourage team members to conduct mutual checks. Small habits create lasting safety.