Standard Operating Procedures for donning and doffing of Personal Protective Equipment (PPE) by laboratory personnel

The following personal protective equipment is required for laboratory personnel while carrying out sample collection from suspected/confirmed case of infectious diseases:

  1. Coverall with hood
  2. Disposable gloves
  3. N95 respirator
  4. Liquid resistant apron
  5. Puncture-proof Boots
  6. Face shield


This procedure must be carried out exclusively in clean room identified for donning procedure. An established protocol facilitates training and compliance. Use a qualified observer to confirm that the protocol is being followed correctly.

  1. Recruit a Trained Observer: The donning procedure is inspected and guided by a qualified observer who verifies visually that all PPE is functional and has been successfully donned. A written checklist will be used by the qualified observer to confirm each stage of donning PPE, and they can help ensure and verify the ensemble’s integrity.
  2. Hydration: The laboratory personnel must have adequate liquid or drinks in order to avoid interruption of sample collection due to thirst or dehydration. PPE requires a tight fitting therefore; one may lose fluid due to perspiration and as a result dehydration may occur.
  3. Remove Personal Clothing and Items: Change into surgical scrubs (or disposable garments) and dedicated washable (plastic or rubber) footwear in a suitable, clean area. No personal items (e.g., jewelry, watches, cell phones, pagers, pens) should be brought into patient room.
  4. Inspect PPE Prior to Donning: Visually inspect the PPE ensemble to be worn to ensure it is in serviceable condition, all required PPE and supplies are available, and that the sizes selected are correct for the laboratory personnel. The trained observer reviews the donning sequence with the laboratory personnel before the laboratory personnel begins and reads it to the laboratory personnel in a step-by-step fashion.
  5. Perform Hand Hygiene: Use an alcohol-based hand rub (ABHR) for hand hygiene to move on to the following stage after using ABHR, let hands dry.
  6. Put on Inner Gloves: Put on first pair of gloves.
  7. Put on Gown or Coverall: Put on your gown or coveralls. Make sure the coverall or gown is spacious enough to allow uninhibited mobility. Make sure the inner gloves’ cuffs are fitted beneath the sleeve of the gown or coverall.
  8. Put on Boot or Shoe Covers.
  9. Put on N95 Respirator: Put on N95 respirator. Complete a user seal check.
  10. Put on Outer Apron (if used): Put on full-body apron to provide additional protection to the front of the body against exposure to body fluids or excrement from the patient.
  11. Put on Outer Gloves: Put on second pair of gloves (with extended cuffs). Ensure the cuffs are pulled over the sleeves of the gown or coverall.
  12. Put on Face Shield: Put-on full-face shield over the N95 respirator and surgical hood to provide additional protection to the front and sides of the face, including skin and eyes.
  13. Verify: The integrity of the ensemble is checked by the qualified observer after the donning procedure is complete. The laboratory personnel should be comfortable and able to extend the arms, bend at the waist and go through a range of motions to ensure there is sufficient range of movement while all areas of the body remain covered. A mirror in the room can be useful for the laboratory personnel while donning PPE.
  14. Disinfect Outer Gloves: Disinfect outer-gloved hands with ABHR. Allow to dry prior to patient contact.

PREPARING FOR DOFFING                            

The goal of this stage is to get ready for the removal of PPE. Inspect and disinfect any detectable contamination on the PPE before entering the PPE removal area. Finally, disinfect outer-gloved hands and allow them to dry. Before entering and beginning the PPE removal process, ensure that the trained observer is present in the PPE removal area.

  1. Hand Hygiene: Perform hand hygiene in the doffing area.
  2. Involve Trained Observer: The doffing technique is carried out under the supervision of a trained observer, who records carefully each step of the operation and visually ensures that the PPE has been correctly removed. Prior to doffing PPE, the trained observer must remind laboratory personnel to avoid reflexive actions that may put them at risk, such as touching their face. Although the trained observer should minimize touching laboratory personnel or their PPE during the doffing process, the trained observer may assist with removal of specific components of PPE as outlined below. The trained observer disinfects the outer-gloved hands immediately after handling any laboratory personnel PPE.
  3. Inspect: Before beginning to remove the PPE, inspect it for apparent contamination, rips, or tears. Disinfect any PPE that is noticeably infected.
  4. Disinfect and Remove Outer Gloves: Remove the outer glove using glove and glove removal technique.
  5. Inspect inner glove: Inspect inner gloves for any visible contamination.
  6. Perform Hand hygiene
  7. Remove Apron: Remove the apron away from the body taking care not to contaminate the coverall. Roll the apron inside out and discard safely in the bio-hazard box.
  8. Perform hand hygiene
  9. Inspect PPE for any visible contamination
  10. Remove Face Shield: Remove the full-face shield by tilting the head slightly forward, grabbing the rear strap and pulling it over the head, gently allowing the face shield to fall forward and discard. Avoid contacting the front of the face shield.
  11. Perform hand hygiene
  12. Remove Gown or Coverall: Depending on gown design and location of fasteners, the laboratory personnel can either untie fasteners, receive assistance by the trained observer to unfasten to gown, or gently break fasteners. During removal, avoid contacting scrubs or disposable clothing with the exterior surface of the gown. Pull gown away from body, rolling inside out and touching only the inside of the gown. To remove coverall, tilt head back to reach zipper or fasteners. Before rolling down and turning inside out, unzip or unfasten the coverall completely. During removal, avoid contact of scrubs with the outer surface of the coverall, touching only the inside of the coverall.
  13. Perform hand hygiene
  14. Disinfect boots if there are visible contamination
  15. Perform hand hygiene
  16. Change Inner Gloves: Remove and discard gloves taking care not to contaminate bare hands during removal process.
  17. Perform hand hygiene.
  18. Don a new pair of inner gloves
  19. Remove N95 Respirator: Remove the N95 respirator by tilting the head slightly forward, grasping first the bottom tie or elastic strap, then the top tie or elastic strap, and Remove the N95 respirator without touching the front and discard N95 respirator.
  20. Perform hand hygiene
  21. Remove gloves safely
  22. Perform hand hygiene
  23. Inspect: Perform a final inspection of laboratory personnel for any indication of contamination of the surgical scrubs or disposable garments. If contamination is identified, immediately inform the laboratory coordinator before exiting PPE removal area.
  24. Remove Boot or  Shoe Covers: While sitting down, remove and discard boot or shoe covers.
  25. Perform hand hygiene
  26. Wear clean slippers or shoes
  27. Remove surgical scrubs
  28. Shower: Showers are recommended after every collection of samples.

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