Nursing care
Personal Protective Equipment: the method, the errors, and the exam
Written and reviewed by Dana Whitfield, RN, MSN · 5 min read · Updated September 2026
Short answer
Personal protective equipment is put on in the order gown, mask, eyewear, gloves, and removed in the reverse order with gloves first, because doffing is where contamination happens: the outside of used PPE is treated as infectious, and the sequence exists to keep that contaminated surface away from skin, hair, and mucous membranes as it comes off.
What the skill is for
PPE creates a physical barrier between the nurse and a patient's blood, body fluids, secretions, or airborne pathogens. It is used according to the type of precaution in place: contact, droplet, airborne, or a combination, and the specific items required change with the precaution type, not just the diagnosis.
The equipment itself is only as safe as the sequence used to put it on and take it off. Donning correctly matters, but it is a low-risk step because nothing on the equipment is contaminated yet. The entire purpose of a fixed doffing sequence is to manage the moment the equipment does carry pathogen load.
The method, step by step
Donning order: perform hand hygiene, then put on the gown, tying it at the neck and waist; then the mask or respirator, moulded to the nose bridge with a secure seal; then goggles or a face shield; then gloves, pulled up to cover the gown's cuffs. This order protects the highest-risk exposure routes, the face and airway, before the hands are gloved and less free to adjust them.
Doffing order is the reverse of exposure risk, not the reverse of donning: gloves first, since they are the most contaminated surface and the easiest to remove without touching skin; then goggles or face shield, lifted by the strap or arms rather than the front; then gown, unfastened and rolled inward so the outer surface never touches clothing; then mask or respirator last, removed by the ties or ear loops without touching the front panel. Hand hygiene follows every doffing sequence, and often between individual steps.
Where it goes wrong
Doffing is where contamination happens, and it happens because the order out matters more than the order in. A nurse who removes the gown before the gloves, or touches the front of the mask to pull it off, transfers pathogen directly from the equipment's outer surface to bare skin. The gloves come off first precisely because everything touched during patient care sits on that outer glove surface.
A second common error is removing the mask too early, before the gown, which exposes the airway to contaminants still on the gown as it is pulled off. A third is skipping hand hygiene between doffing steps, so contamination from the first item removed is carried onto the second. Reusing a gown between patients, or leaving goggles pushed up on the forehead where the outer surface can contact hair and skin, are also common breaches.
Practising it deliberately
Rehearse doffing more than donning, since that is where the risk concentrates. Practise in front of a mirror or with a partner watching for hand-to-face contact, and narrate each step out loud: name the item, name why it comes off in that position in the sequence, and state where hand hygiene falls.
Simulate a scenario where you must doff quickly, since real shifts create time pressure that tends to compress or skip steps. Practising the slow, correct sequence under simulated urgency is what keeps it intact when a real emergency call interrupts a doffing sequence at the bedside.
Applying it on the exam
NCLEX questions on PPE most often ask you to sequence removal correctly or to identify a break in technique from a described scenario. Expect the correct doffing order tested directly: gloves, goggles or face shield, gown, mask.
Other items test matching precaution type to required equipment, for example an N95 respirator for airborne precautions such as tuberculosis versus a surgical mask for droplet precautions such as influenza. A stem describing a nurse touching the front of their mask, or removing a gown before gloves, is testing recognition of a doffing error, and the correct response is usually to identify the break and redo hand hygiene, not to continue the sequence as started.
A worked example
A nurse finishes caring for a patient on contact and droplet precautions for influenza and needs to leave the room to answer another call bell. Reaching for speed, the nurse pulls off the gown first, then the gloves, then the mask by its front panel. Each step transfers contamination from equipment to skin, because the sequence should have been gloves first, then goggles, then gown, then mask by the ties.
The correct action, once the nurse recognises the error, is to stop, perform hand hygiene, and complete hand hygiene again after leaving the room, and to flag the breach if there was any mucous membrane or skin contact with a contaminated surface. This scenario tests whether the candidate can spot a specific sequencing error rather than just recite the correct order from memory.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our safe and effective care practice questions are the closest set to what this page covers.
One question from the safe and effective care set
A nurse on a medical unit receives report on four clients. Which client should the nurse assess first?
Rationale
Prioritization items are airway, breathing, circulation, in that order — the ranking survives every rewording. Audible gurgling around a fresh tracheostomy is a partially obstructed airway and it is the only option that can kill the client in the next few minutes. Fever, post-op pain, and a glucose of 232 are all real problems that need the nurse, just not first.
Answer: C
Common questions
What is the correct order to remove PPE?
Gloves first, then goggles or face shield, then the gown, and the mask or respirator last, removed by its ties or ear loops without touching the front panel. Hand hygiene is performed after removal, and often between individual steps.
Why does the doffing order matter more than the donning order?
Because doffing is where contamination happens. During donning, none of the equipment carries pathogen load yet. By the time PPE is removed, the outer surfaces have been exposed to the patient's environment, so the order exists specifically to keep that contaminated surface away from skin, hair, and mucous membranes.
What PPE is required for airborne precautions?
An N95 or higher-level fitted respirator is required for airborne precautions, such as tuberculosis or measles, rather than the standard surgical mask used for droplet precautions like influenza. Eye protection, gown, and gloves are added according to the specific exposure risk.
What should a nurse do if PPE is accidentally contaminated during doffing?
Stop the sequence, avoid touching the affected area again, and perform hand hygiene immediately. Any contact between a contaminated surface and skin or mucous membranes should be reported per facility policy, since it represents a potential exposure.
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