This guide covers the donning (putting on) and doffing (taking off) of personal protective equipment (PPE) when dealing with patients who are suspected or confirmed to have COVID-19. This article is based on the latest guidance from the UK Government. 1,2,3
The article provides PPE guidance for both aerosol-generating procedures (AGPs)1 and non-aerosol generating procedures (non-AGPs).2
The highest risk of transmission of respiratory viruses is during AGPs of the respiratory tract, and use of enhanced respiratory protective equipment is indicated for health and social care workers performing or assisting in such procedures.3
The UK Government has defined aerosol-generating procedures (AGPs) as any of the following:3
intubation, extubation and related procedures, for example, manual ventilation and open suctioning of the respiratory tract (including the upper respiratory tract)
tracheotomy or tracheostomy procedures (insertion or open suctioning or removal)
bronchoscopy and upper ENT airway procedures that involve suctioning
upper gastrointestinal endoscopy where there is open suctioning of the upper respiratory tract
surgery and post mortem procedures involving high-speed devices
some dental procedures (for example, high-speed drilling)
All PPE should be put on OUTSIDE of the patient’s room and where possible should be supervised by a buddy at a distance of 2 metres.
A buddy is a member of staff also trained and competent in the use of PPE.
Don a surgical gown or coveralls
You should have access to either a surgical gown or a coverall.
1. Put on the disposable gown
2. Do not use the inside tie
3. Fasten the necktie/velcro and waist ties securely
1. Step into the coveralls
2. Pull the coveralls up to your waist
3. Insert your arms into the sleeves:
If thumb hoops are available then hoop these over your thumbs
Ensure the sleeves are long enough to reach the glove cuffs to avoid skin exposure
4. Pull the coveralls up over your shoulders
5. Fasten the zip all the way to the top
Don a respirator
The respirator you use MUST be one you have already been fit-tested for:
1. Position the upper straps of the respirator on your head, above your ears.
2. Position the lower strap at the nape of your neck.
3. Ensure the respirator is positioned flat against your cheeks.
4. Mould the nose piece, using both hands, pressing down both sides of your nose with your fingers until you have a good facial fit.
5. Perform a fit-check (the technique differs depending on the respirator model, follow the manufacturer instructions):
For an unvalved product, exhale sharply to test
For a valved product, inhale sharply to test
If air flows around the nose, readjust the nose piece
If air flows around the edges of the respirator, readjust the headbands
If an adequate fit cannot be achieved, you should NOT PROCEED
If wearing glasses:
Remove glasses before donning the respirator
Clean them with an alcohol lens wipe
Replace them before donning the visor
Don eye protection
1. Place the eye protection over your face and eyes:
a disposable full-face visor is preferred
goggles may be used if a visor is not available
if using a visor, ensure it covers all of your face including your chin
2. Adjust the headband to achieve a secure fit
3. If a buddy is not available, you will need visible confirmation that the visor is in the correct position
1. Put on a pair of non-sterile, nitrile gloves
2. Choose gloves that are the appropriate size to ensure they fit you correctly
3. Pull each glove cuff to cover the cuff of each gown sleeve (to avoid skin exposure)
Before entering the patient room, you need to perform a final check that:
the gown ties at the neck and waist are secure
the respirator is correctly fitted
the visor is in the correct position
the gloves are covering the cuffs of the gown/coverall
Once you are confident all steps have been completed, you can enter the patient area. After entering the patient’s room, remain vigilant of both your own and your colleague’s PPE integrity.
In the event of a high exposure episode (e.g. projectile vomiting) or if there are concerns about PPE integrity, LEAVE THE ROOM at the earliest opportunity and inform your buddy prior to removing any PPE.
Putting on PPE for AGPs video demonstration
Taking off PPE (Doffing)
Where possible, the process of removing PPE should be supervised by a buddy at a distance of two metres.
The buddy can assist you when removing your PPE to reduce the risk of you contaminating yourself.
DO NOT step into the clean area whilst wearing contaminated PPE.
If you become aware of a potential PPE breach or high-exposure contamination (e.g. projectile vomiting), inform your buddy before removing your PPE.
Remove your gloves
1. Grasp the outside of your glove with your opposite gloved hand and peel off
2. Hold the removed glove in your gloved hand
3. Slide the fingers of your ungloved hand under your remaining glove at the wrist and peel the remaining glove off over the first glove
4. Dispose of both gloves into the clinical waste bin
5. Clean your hands with alcohol hand gel or rub (if not available, use soap and water)
Remove your surgical gown
The surgical gown should be removed slowly and carefully:
1. Undo the necktie
2. Undo the waist tie
3. Pull the surgical gown away from your neck and shoulders (touching the inside of the gown only) using a peeling motion, as the outside of the gown will be contaminated
4. Turn the gown inside out, fold into a bundle and discard immediately into a clinical waste bin
Remove your visor
1. To remove the visor, ensure you are standing straight and not bending forward (as this brings the bottom of the visor in contact with the clean upper body)
2. Reach for the elastic strap at the back of your head, close your eyes and lift the strap upwards and then over your head using both hands
3. Place the visor into the clinical waste bin immediately
4. Leave the patient’s room whilst still wearing your respirator
5. Clean your hands with alcohol gel or rub
Remove your respirator
1. Carefully remove the FFP3 respirator without touching the front of the device which is contaminated
2. Reach to the back of your head with both hands to find the bottom strap and bring it up to the top strap
3. Lift both straps over the top of your head
4. Let the respirator fall away from your face and drop it into the clinical waste bin
5. You can now leave the designated doffing area and immediately wash your hands with soap and water
If wearing glasses:
Remove them before removing the respirator
Clean your glasses with an alcohol lens wipe
Do not put your glasses back on until you have completed the removal of the respirator and have washed your hands once more
Taking off PPE for AGPs video demonstration
UK Government. Guidance: COVID-19: personal protective equipment use for aerosol-generating procedures. Published 10th January 2020. Last updated 10th April 2020. Accessed 15th April 2020. Available from: [LINK]
UK Government. Guidance: COVID-19: personal protective equipment use for non-aerosol generating procedures. Published 10th January 2020. Last updated 8th April 2020. Accessed 15th April 2020. Available from: [LINK]
UK Government. Guidance: Personal Protective Equipment (PPE). Last updated 12th April 2020. Accessed 15th April 2020. Available from: [LINK]