Donning of PPE Checklist for Airborne Precaution

S = Satisfactory U = Unsatisfactory NP = Not Performed

S U NP
Procedure Comments
2 1 0
1. Perform hand hygiene (verbalize)
2. Put on the gown by sliding it up the arms, and
insert the thumbs into the thumb inserts of the
gown (if present). This particular gown has a
loop that you can place over your head. Then,
secure the gown by tying the ties in the back.

3. Hold the respirator in one hand, with the

front of the respirator touching the inside of
your hand. The metal nose piece should rest
near the fingertips. Be sure the top and bottom
straps of the respirator are hanging down below
your hand and are not tangled or twisted
4. Take the respirator and place it over your
nose, mouth, and under the chin.
5. Hold the respirator in place with one hand.

6. Use your free hand to place the straps on

your head. It’s very important the straps rest on
the head and are NOT overlapping or tangled.

7. First, take the top strap of the respirator and

place it just past the top of your head, above the
ears.

8. Then take the bottom strap of the respirator

and place it around the bottom of the head, just
below the ears, and then make sure the straps
aren’t overlapping or overly twisted
9. To ensure a proper seal of the respirator
around the nose area, use the fingertips of both
hands to bend the metal nose piece around the
nose, starting in the center and working your
way outward on each side.

10. Perform a Seal Test: Place both hands over

the respirator. With verbalizations.
10.a Take a sharp breath in and make sure that
the respirator is sealing over the face during this
inhalation.
10.b Keep both hands on the respirator and
breathe out. While breathing out, feel for any air
leaking around the nose piece and around the
respirator’s perimeter.
10.c If air is leaking around the nose piece, try
re-bending the nose piece with both hands and
recheck the seal.
10.d If air is leaking around the respirator’s
perimeter, try adjusting the straps and recheck
again, making sure the respirator is not being
affected by any piercings, facial hair, or glasses,
which could prevent a proper seal.
10.e If the respirator still leaks after this, you
may need a different size or type of respirator.
Do NOT use the respirator if a proper seal has
not been obtained. (verbalize)
11. Don a face shield or goggles: If using goggles,
apply goggles over the eyes. Make sure any
straps or bands of the goggles are secured
around the head and the goggles fit snugly but
comfortably.

12. Perform hand hygiene again.

(Verbalization)
13. don gloves by pulling each glove over the
hand and extending the cuff of the gloves over
the sleeves of the gown.
Perfect Score: 26 TOTAL
Passing Score: 21
 Doffing of PPE Checklist for Airborne Precaution

S = Satisfactory U = Unsatisfactory NP = Not Performed

S U NP
Procedure Comments
2 1 0
1. To remove the gloves, start by taking your
non-dominant gloved hand to grab the other
glove around the cuff in the wrist area. Do this
by using a pinching motion to grab it. Peel this
glove off by turning it inside out, and wad it into
a ball with your gloved hand. Keep it securely in
your gloved hand.
2. Take the index finger of the ungloved hand
and slide it carefully under the cuff of the gloved
hand and peel the glove off the hand by pushing
the index finger forward against the glove. This
will turn the glove inside out.

3. Dispose of the gloves to infectious waste bin

(yellow).
4. Next, remove the gown. The front of the
gown and sleeves are considered contaminated,
whereas the ties and inside of the gown are
considered clean. Therefore, avoid touching the
front of the gown and sleeves. Carefully untie or
break the ties of the gown.
5. Peel off the gown by removing the thumbs
from the inserts (if present), and then move the
shoulders and arms up through the gown, which
helps allow the gown to slide off the body.
6. Then from the inside, with the assistance of
the arms, roll the gown away from the body by
turning it inside out.

7. Form it into a ball and discard it to infectious

waste bin.
8. Perform hand hygiene. (verbalization)

9. Next, remove the face shield or goggles. Do

NOT touch the outside of the googles or face
shield because they are considered
contaminated. If goggles are used, remove the
goggles by carefully grasping and lifting the back
band of the goggles over the head. Dispose or
clean the goggles per facility’s protocol.
 10. If a respirator is worn, the doffing procedure
is performed outside the patient’s care area.
The front of the respirator is considered
contaminated. Therefore, remove by the straps.
Grasp the BOTTOM strap of the mask and lift it
over the head.
11. Then grasp the TOP strap of the mask and lift
it over the head.

12. Perform hand hygiene.

Perfect Score: 24 TOTAL

Passing Score: 19

References:

Donning and Doffing Personal Protective Equipment (PPE) (2020). Retrieved from
https://www.registerednursern.com/donning-and-doffing-ppe-nclex-review/

Using Personal Protective Equipment (PPE). (2020). Retrieved from

https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html