Editing Infection Control and Safety (section)

== Personal Protective Equipment ==

PPE is selected by the anticipated exposure, not by diagnosis alone. It is the last line of defense in the hierarchy of controls, which places elimination, engineering controls (ventilation, sharps devices, closed suction), and administrative controls (policies, staffing, vaccination, screening) ahead of PPE.

=== Donning sequence ===

# Perform hand hygiene.
# '''Gown''': fasten at the neck and waist, cover the torso from neck to knees and the arms to the wrists, and wrap around the back.
# '''Mask or respirator''': secure ties or elastic bands, fit the flexible band to the nose bridge, fit snug to the face and below the chin, and perform a seal check for a respirator.
# '''Goggles or face shield''': place over the face and eyes and adjust to fit. Personal eyeglasses are not a substitute.
# '''Gloves''': don last and extend them to cover the cuff of the gown.

=== Doffing sequence ===

The principle is to remove the most contaminated items first and to avoid touching the front of any item.

# '''Gloves''': the outside is contaminated. Grasp the outside of one glove at the palm and peel it off, hold it in the gloved hand, slide ungloved fingers under the remaining glove at the wrist, and peel it off over the first. Discard.
# '''Goggles or face shield''': the outside is contaminated. Handle by the headband or earpieces only.
# '''Gown''': unfasten ties, pull away from the neck and shoulders touching the inside only, turn it inside out, and roll it into a bundle.
# '''Mask or respirator''': the front is contaminated. Untie or remove the bottom band first, then the top, and handle by the ties or bands only.
# Perform hand hygiene immediately, and at any point during removal if the hands become contaminated.

'''Where to remove.''' Remove all PPE before leaving the patient room '''except''' a respirator, which is removed after exiting and closing the door. An acceptable alternative is to remove the gown and gloves together at the doorway by grasping the gown front, pulling away from the body so the ties break, and rolling it into a bundle with the gloves turned inside as they are peeled off.

'''Gloves are never a substitute for hand hygiene.''' Change gloves between patients and between a contaminated and a clean site on the same patient, and perform hand hygiene at every glove change. Latex allergy requires nitrile or vinyl gloves and a latex-safe environment; ask about allergy to bananas, avocados, kiwi, and chestnuts, which cross-react.