PPE Order for CNAs: Donning and Doffing Sequence (with Memory Trick)

Personal protective equipment (PPE) questions appear on every NNAAP written exam — and they are among the most commonly missed questions in the Infection Control section. The reason is not that the content is complex; it is that students memorize the wrong order or mix up donning (putting on) with doffing (taking off). The NNAAP tests PPE order in two ways: asking which item goes on first (or last), and asking which item comes off first (or last) when leaving an isolation room. These are specific, unambiguous questions with one correct answer. Get the sequence right and you pick up guaranteed points. Get it wrong and you miss a question that has nothing to do with memorizing drug names or diagnosis criteria — just procedure.

Donning means putting PPE on before entering an isolation room. The correct CDC order is: 1. **Gown** — Always first. The gown is your largest barrier. It protects your clothing and skin, and everything else layered over it. Tie the gown at the neck and waist. 2. **Mask or respirator** — Second. For most isolation rooms, this is a surgical mask. For airborne precautions (TB, measles, chickenpox), this is an N95 respirator. Putting the mask on before goggles ensures the mask ties don't contaminate the eye protection. 3. **Eye protection** — Third. Goggles or a face shield are applied after the mask so you can position them over the mask ties. 4. **Gloves** — Last. Gloves go on after the gown so they can cover the cuffs of the gown, sealing the wrist gap. **Memory trick for donning:** "Great Masks Entertain Guests" → Gown, Mask, Eye protection, Gloves. (Donning only — do not use this for doffing.) **Memory trick for doffing:** Alphabetical — Gloves → Goggles → Gown → Mask. Three G's first, mask last. The most common mistake on this question is selecting mask first or gloves first. Gown always goes on first.

Doffing means removing PPE after leaving the patient's room (or just inside the doorway). The correct CDC order is the reverse of contamination risk — remove the most contaminated items first: 1. **Gloves** — First. Your gloves have had direct contact with the patient and contaminated surfaces throughout the visit. They come off first, before you touch anything else. 2. **Eye protection** — Second. Goggles or face shield come off before the gown. Without gloves, you can grasp the outside of the goggles at the arms and lift them away from your face without contaminating yourself. 3. **Gown** — Third. Unfasten the ties, grasp the inside of the gown (the clean surface), peel it away from the outside (the contaminated surface), and roll it inward as you remove it. 4. **Mask** — Last. The mask is removed last because it continues to protect your respiratory tract while you are removing the other contaminated items. Remove it by grasping the ties or earloops — never touch the front of the mask. **Perform hand hygiene after removing gloves and again after removing the mask.** **Memory trick for doffing:** "Gloves Exit, Goggles, Gown, Mask" → GEGGM. Or: think of peeling off layers from most dirty to least dirty, and remember that your face/respiratory protection stays on the longest. The most common mistake is removing the gown before the eye protection, or removing the mask before the gown.

Here is the complete donning and doffing sequence side by side: | Step | Donning (Putting On) | Doffing (Taking Off) | |------|---------------------|---------------------| | 1 | Gown | Gloves | | 2 | Mask/Respirator | Eye protection | | 3 | Eye protection | Gown | | 4 | Gloves | Mask/Respirator | Notice that donning and doffing are not exact reverses of each other. Donning goes: gown → mask → eyes → gloves. Doffing goes: gloves → eyes → gown → mask. The mask moves from second position when putting on to last position when taking off, because you want respiratory protection to remain in place as long as possible.

Based on what the Infection Control section tests, these are the mistakes that cost students points: **Donning mistakes:** • Selecting mask as the first item — gown is always first • Selecting gloves as the first item — gloves are always last • Thinking eye protection goes before the mask — mask comes second, eye protection third **Doffing mistakes:** • Removing the gown before the gloves — gloves come off first • Removing the mask before the gown — mask comes off last • Forgetting to perform hand hygiene after removing gloves — this step is required before touching anything else If a question asks "which piece of PPE should be removed LAST?" — the answer is the mask. If it asks "which piece should be removed FIRST?" — the answer is gloves.

Not every patient encounter requires all four items. Standard precautions guide when each item is needed: • **Gloves**: Any time you may contact blood, body fluids, non-intact skin, or mucous membranes. • **Gown**: When splashing or spraying of body fluids is possible, or when entering the room of a patient on contact precautions. • **Mask**: When spraying or splashing near your face is possible (standard precautions), or when entering the room of a patient on droplet or airborne precautions. • **Eye protection**: When splashing or spraying of body fluids near your eyes is possible. For transmission-based precautions, the full sequence applies every time you enter the room — gown, mask, eye protection, gloves — and you remove all of them (in doffing order) before leaving the immediate area.

The correct donning order for PPE is: (1) Gown, (2) Mask or respirator, (3) Eye protection (goggles or face shield), (4) Gloves. The gown goes on first because it is the largest barrier and everything else layers over it. Gloves go on last so they cover the wrists of the gown. This is the order tested on the NNAAP exam and required by CDC guidelines.

The correct doffing order for PPE is: (1) Gloves, (2) Eye protection, (3) Gown, (4) Mask. Gloves come off first because they are the most contaminated after direct patient care. The mask comes off last to maintain respiratory protection while you remove the other contaminated items. Perform hand hygiene after removing gloves and again after removing the mask.

The gown is applied first because it is the largest piece of PPE and serves as the foundation layer. When you put the mask on second, you can position the mask ties or straps without contaminating already-worn eye protection or gloves. If you put the mask on last, you would have to reach around your goggles and gloves to tie it, which risks contaminating your face or gloves. Systematic donning from largest to smallest item, with respiratory protection before eye protection, ensures each piece is applied cleanly.

The mask is removed last during doffing because it provides respiratory protection. While you are removing your contaminated gloves, gown, and eye protection, you are still in the doorway or immediate environment of the isolation room. Keeping your mask on until all other PPE has been removed and disposed of maintains respiratory protection throughout the doffing process. Once everything else is off and your hands are clean, you remove the mask by grasping the ties or ear loops — never by touching the front.