Lesson · 24 min

PPE and Transmission-Based Precautions

Choose, don, and remove protective equipment correctly, and apply the additional precautions specific pathogens require.

By the end of this lesson you can

Select PPE appropriate to the task and the pathogen
Describe the correct sequence for donning and doffing
Distinguish contact, droplet, and airborne precautions
Explain what makes doffing the highest-risk moment

📘 Reading Lesson

Lesson Notes

Read through the key concepts before you try the challenge.

The order matters more than the equipment

On the job

You prepare to assist with a procedure at Lakeside Medical Associates.

You put on gown, gloves, mask, and eye protection correctly. Afterwards you pull the gown off over your head, brushing the contaminated front across your face, and drop your gloves on the counter. Every item was correct and the removal undid all of it.

Your task: Learn the sequences, because doffing is where contamination actually happens.

PPE is selected by the task and the expected exposure, not by habit. Gloves for contact with blood, body fluids, mucous membranes, or non-intact skin. A gown when clothing may be soiled. A mask and eye protection when splashes or sprays are possible. A respirator rather than a mask for airborne pathogens.

Donning — put on	Doffing — take off
1. Gown	1. Gloves
2. Mask or respirator	2. Eye protection
3. Eye protection	3. Gown
4. Gloves — over the gown cuffs	4. Mask or respirator — last, and outside the room

Donning and doffing sequences

Doffing is the highest-risk moment in the entire sequence, because everything you are removing is contaminated on the outside. Gloves come off first because they are the most contaminated. The mask comes off last because it protects you while you handle everything else, and it is removed by its ties or ear loops — never by touching the front. Hand hygiene follows immediately, and is also performed between steps if you contaminate your hands.

Type	For	Requires	Examples
Contact	Spread by direct or indirect touch	Gown and gloves; dedicated equipment	C. difficile, MRSA, scabies
Droplet	Spread by respiratory droplets over short distances	Surgical mask; patient masked during transport	Influenza, pertussis, mumps
Airborne	Spread by small particles that remain suspended	N95 or higher respirator, fit-tested; negative-pressure room	Tuberculosis, measles, varicella

Transmission-based precautions

Transmission-based precautions are applied in addition to Standard Precautions, never instead of them. Some conditions require more than one type — varicella requires both airborne and contact precautions, for example.

A surgical mask and an N95 respirator are not interchangeable. A surgical mask blocks large droplets and protects the patient from you. An N95 filters small airborne particles and protects you — but only if it is fit-tested to your face and you have passed a seal check. An unfitted N95 provides substantially less protection than its rating suggests, which is why fit testing is a requirement rather than a formality.

Check your understanding

Why are gloves removed first when doffing PPE?

Challenge

Apply what you've learned in this lesson.

PPE technique is a psychomotor skill. Reading about it is preparation for practicing it under supervision, not a substitute.

Find the CDC's PPE donning and doffing sequence poster. Write both sequences from memory, then check.
For each scenario, list the PPE required: a routine blood draw; assisting with a procedure where splashing is likely; caring for a patient on contact precautions; entering the room of a patient with suspected tuberculosis.
Research what an N95 fit test involves and why it must be repeated periodically.
Practice the doffing sequence with any substitute materials you have. Identify the two points where you were most likely to contaminate yourself.

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