Introduction to PPE Removal
Personal protective equipment (PPE) includes items such as gloves, gowns, masks, respirators, face shields, goggles, and head covers. PPE acts as a barrier between infectious agents and the wearer, but it can become contaminated during use. Therefore, removing PPE correctly is as important as putting it on properly. Improper removal can lead to the transfer of infectious agents from contaminated PPE onto the skin or clothing, increasing the risk of infection transmission.
The goal of PPE removal procedures is to prevent contact with contaminated surfaces of PPE and to do so in a way that reduces the chance of self-inoculation or environmental contamination. The correct order typically involves removing the most contaminated items first, followed by items that are less contaminated, all while maintaining proper hand hygiene throughout the process.
Importance of the Correct PPE Removal Sequence
Following a standardized sequence for PPE removal offers several benefits:
- Reduces Self-Contamination: Proper sequence minimizes contact with contaminated surfaces.
- Prevents Cross-Contamination: Ensures that pathogens are not transferred from PPE to other surfaces or individuals.
- Maintains Safety Protocols: Ensures compliance with infection control guidelines.
- Protects Healthcare Workers and Patients: Limits the spread of infectious agents within healthcare settings or laboratories.
- Promotes Confidence and Professionalism: Demonstrates adherence to safety standards.
Principles Underlying PPE Removal
Before discussing the specific sequence, it’s important to understand some core principles:
- Avoid Touching Contaminated Surfaces: Do not touch the outside of gloves or other PPE with bare hands.
- Perform Hand Hygiene Frequently: Use alcohol-based hand sanitizer or soap and water when appropriate.
- Remove PPE in a Controlled Manner: Follow a step-by-step approach to prevent accidental contamination.
- Use Proper Technique: For example, gloves should be removed inside out to contain contamination.
- Disposal: Properly discard PPE in designated waste containers.
- Environmental Decontamination: Clean hands thoroughly after PPE removal.
Step-by-Step Guide to the Correct Order to Remove PPE
The following sequence is widely recommended by infection control agencies such as the CDC (Centers for Disease Control and Prevention) and WHO (World Health Organization). It may vary slightly depending on specific settings or PPE used, but the core principles remain consistent.
1. Remove Gloves
Why first? Gloves are often the most contaminated PPE item, especially after contact with infectious materials.
Procedure:
- Grasp the outside of one glove at the wrist, being careful not to touch your skin.
- Peel the glove away from your hand, turning it inside out.
- Hold the removed glove in the gloved hand.
- Insert fingers of the ungloved hand under the remaining glove at the wrist.
- Peel off the second glove over the first glove, turning it inside out.
- Dispose of gloves properly in waste container.
Note: Gloves are the primary source of contamination; removing them first reduces the risk of contaminating other PPE.
2. Perform Hand Hygiene
Immediately after glove removal, perform hand hygiene. Use alcohol-based hand sanitizer if hands are not visibly dirty; otherwise, wash with soap and water.
Why? To eliminate any residual pathogens that could have been transferred during glove removal.
3. Remove Gown
Why next? The gown may be contaminated on the outer surface.
Procedure:
- Untie or break fasteners without touching the contaminated exterior.
- Carefully pull the gown away from the neck and shoulders, touching only the inside surface.
- Pull the gown downwards, turning it inside out as you go.
- Fold or roll the gown into a bundle, avoiding contact with the outside.
- Dispose of it in an appropriate waste container.
Tip: Hold the gown away from your body and avoid contact with your clothing or skin.
4. Perform Hand Hygiene Again
After gown removal, perform hand hygiene to remove any potential contaminants.
5. Remove Face Mask or Respirator
Why after gown? The face mask or respirator may be contaminated on the outside.
Procedure for Surgical Mask:
- Grasp the ear loops or ties without touching the front.
- Remove the mask by lifting the ear loops or untie the straps.
- Handle only the ties or ear loops; do not touch the mask's front.
- Discard in waste container.
Procedure for N95 Respirator:
- Remove the respirator by grasping the straps, starting with the bottom strap.
- Lift away from your face without touching the front.
- Discard appropriately.
Note: If the mask or respirator is contaminated with infectious material, it should be discarded in designated waste.
6. Remove Eye Protection (Goggles or Face Shield)
Why last? Eye protection may be contaminated on the outer surface.
Procedure:
- Handle the headband or earpieces.
- Lift the goggles or face shield away from the face.
- Avoid touching the front surface.
- Clean and disinfect if reusable or discard if disposable.
7. Final Hand Hygiene
Once all PPE items are removed, perform thorough hand hygiene again. Use soap and water or an alcohol-based hand sanitizer.
Additional Tips for Safe PPE Removal
- Use Proper PPE Disposal Containers: Discard PPE in designated biohazard or waste bins to prevent environmental contamination.
- Avoid Touching the Outside of PPE: Treat all PPE surfaces as contaminated.
- Follow Local Guidelines: Different institutions may have specific protocols; always adhere to local policies.
- Training and Practice: Regular training ensures staff are familiar with proper procedures.
- Use of Assistants: In some settings, trained personnel or observers can oversee PPE removal to ensure compliance.
Special Considerations in PPE Removal
Certain environments or PPE types may require modifications to the standard sequence.
1. During Aerosol-Generating Procedures
- Use enhanced PPE such as N95 respirators, face shields, and gowns.
- Follow strict removal sequences to prevent aerosolized pathogens.
2. For Reusable PPE
- Follow appropriate decontamination procedures before reuse.
- Inspect PPE for damage before reuse.
3. In Resource-Limited Settings
- Prioritize PPE removal steps based on available resources, but never compromise safety.
Common Mistakes to Avoid
- Touching the outside of PPE with bare hands during removal.
- Rushing through the process without performing hand hygiene.
- Touching or adjusting PPE during removal.
- Not disposing of PPE properly.
- Skipping hand hygiene between steps.
Conclusion
The correct order to remove PPE is a critical component of infection prevention and control. By following a systematic sequence—gloves first, followed by gown, mask or respirator, eye protection, and ending with hand hygiene—healthcare workers and others can significantly reduce the risk of self-contamination and environmental spread of infectious agents. Proper training, adherence to guidelines, and diligent practice are essential to maintain safety standards and protect both healthcare providers and the community.
Remember, PPE removal is not a step to be rushed; it requires attention, care, and discipline. Always stay informed about the latest protocols from reputable health organizations and ensure your practices align with current recommendations to ensure safety and effectiveness.
Frequently Asked Questions
What is the correct sequence to remove PPE to prevent contamination?
The correct order is to remove gloves, then goggles or face shield, followed by gown, and finally mask or respirator, ensuring proper hand hygiene between steps.
Why is it important to remove PPE in a specific order?
Removing PPE in the correct sequence minimizes the risk of self-contamination by ensuring contaminated surfaces are handled last and hands are cleaned properly after each step.
Should I remove the gown before or after removing gloves?
You should remove gloves first, then the gown, to prevent contaminating your hands with potentially contaminated surfaces of the gown.
Is it necessary to perform hand hygiene after removing each piece of PPE?
Yes, performing hand hygiene after removing each piece of PPE significantly reduces the risk of transferring pathogens to yourself or others.
What precautions should be taken when removing face shields or goggles?
Handle face shields or goggles by the straps or headband, avoiding contact with the front surface, and perform hand hygiene immediately afterward.
Are there specific considerations for removing PPE in non-healthcare settings?
Yes, even outside healthcare, follow the same sequence—gloves, eye protection, gown, mask—while maintaining hand hygiene—to prevent cross-contamination.
