On in Order, Off in Order: PPE Sequence and Hand Hygiene

Strip 1 · DON, in this order

1. Perform hand hygiene.
2. Gown, tied at the neck and the waist, fully covering the torso from neck to knees and the arms to the wrist.
3. Mask or respirator, secured at the back of the head or neck, nosepiece fitted, and for a respirator a user seal check.
4. Goggles or face shield, positioned over the face and eyes and adjusted.
5. Gloves last, pulled over the gown cuff.

Strip 2 · DOFF, in this order

1. Gloves, peeled off without touching the outer surface.
2. Goggles or face shield, handled by the headband or earpieces only.
3. Gown, unfastened and pulled away from the neck and shoulders, turned inside out and rolled.
4. Mask or respirator, handled by the ties or elastics only, never by the front.
5. Hand hygiene immediately after all PPE is removed.

CDC also publishes an alternative in which the gown and gloves are removed together as one unit, the gown pulled forward and the gloves peeled off inside the rolled gown.

Watch outDo not carry this order forward from a previous printing. The CDC PPE sequence has been revised. Re-verify the donning order, both doffing variants, and the removal location against the current CDC PPE sequence document and record that document's revision date at reprint.

Strip 3 · WHERE each item comes off

• Gloves, eye protection, and gown come off at the doorway or in the anteroom.
• The respirator comes off after leaving the room and closing the door. This is the most tested spatial detail in the sequence.

Strip 4 · Hand hygiene beats

• Before donning.
• Immediately if the hands become contaminated during removal.
• Immediately after all PPE is off.
• Gloves never substitute for hand hygiene.

Strip 5 · Agent choice

• Alcohol-based rub for routine decontamination of hands that are not visibly soiled.
• Soap and water when hands are visibly soiled, after known or suspected exposure to spore-forming organisms, and after using the restroom.

Strip 6 · Respirator rules

• Fit testing before first use and repeated on the schedule policy requires.
• A user seal check every single time it is donned.
• Facial hair crossing the sealing surface defeats the seal.

Strip 7 · Glove rules

• Change between a contaminated task and a clean task on the same patient.
• Remove before touching the environment, the chart, or a phone.
• Never wash and reuse a single-use glove.

Memory hookGloves off first, mask off last.

Margin noteDoffing is not donning reversed.

TakeawayDoffing is not donning reversed, and the door decides where each item comes off.