Healthcare personnel understand the importance of PPE in preventing the spread of infection. Although, selecting and correctly using protective equipment is essential to safeguard both patients and staff, proper removal of PPE is a critical step that is often overlooked.
After providing patient care, PPE should be removed in a careful and deliberate sequence to avoid self-contamination. Once their interaction with a patient is finished, staff may mistakenly assume the highest-risk portion of care is over. In reality, most self-contamination occurs during the PPE removal process.
Common mistakes during PPE removal include taking items off in the incorrect order, contaminating surfaces while doffing, and improperly disposing of soiled PPE. Numerous studies show that many healthcare workers do not follow the correct removal sequence, and even among those who do, most still fail to dispose of PPE appropriately.
Link – Variation in healthcare worker removal of PPE
When PPE is removed incorrectly, the risk of self-contamination may increase significantly. Research has shown that nearly 30% of healthcare workers contaminate themselves while doffing PPE, with almost half experiencing contamination in multiple areas. The arms and abdominal area of clothing are among the most frequently contaminated sites. In one study, over 20% of healthcare staff who agreed to have their skin swabbed after caring for a patient with a viral infection had viral material on their hands.
According to the CDC and OSHA guidelines, healthcare workers are required to receive both initial and ongoing training in the use of PPE. Although annual training is mandated, it may be conducted more frequently based on need. Beyond selecting and donning protective equipment properly, it is essential that staff are thoroughly trained to remove PPE properly.
Effective strategies to improve staff compliance with proper PPE removal include refresher education and the use of simulation-based training. Simulation offers a safe environment where staff can practice repeatedly while receiving real-time feedback. Additionally, incorporating visual reminders such as signage and checklists have been shown to enhance adherence to correct doffing procedures.
Link – CDC Proper Sequence for Donning and Doffing PPE
References:
Phan, L. T., Sweeney, D., Maita, D., Moritz, D. C., Bleasdale, S. C., & Jones, R. M. (2019). Respiratory viruses on personal protective equipment and bodies of healthcare workers. Infection Control & Hospital Epidemiology, 40(12), 1356–1360. doi:10.1017/ice.2019.298
Sahay, N., Naaz, S., Singh, P. K., Kumar, R., Ranjan, A., & Vivekanand (2022). Risk of self-contamination because of improper doffing of personal protective equipment: A randomised cross-over study. Indian journal of anaesthesia, 66(9), 638–643. https://doi.org/10.4103/ija.ija_241_22
Variation in health care worker removal of personal protective equipment. (2015). American Journal of Infection Control, 43(7), 750–751.
Weinreb, Y., Keyes, C., & Bressler, T. (2025). PREVENT THE WORST, PPE FIRST! IMPROVING PERSONAL PROTECTIVE EQUIPMENT (PPE) ADHERENCE WITH THE USE OF EDUCATION AND SIMULATION IN THE AMBULATORY CANCER CENTER: P316. Oncology Nursing Forum, 52(2), 186–187.