Personal Protective Equipment
(PPE)
Donning & Doffing
Trainer’s Guide
November 21, 2014
Saskatchewan Association for Safe Workplaces in Health (SASWH)
Personal Protective Equipment (PPE)
Donning & Doffing
Trainer's Guide
as of November 21, 2014
Enhancements/Revisions
SASWH strongly recommends that PPE instructors and trainers visit its website
(www.saswh.ca) often as it may be necessary to update this information as
revisions are made available. SASWH’s commitment is to provide new PPE
instructors with the most current information, and to notify existing instructors
when revisions to this material are available.
Disclaimer
This program is provided on an “as is” basis. Due to the diverse conditions under
which this program may be applied, it is provided to you without any warranties or
representations expressed or implied. Saskatchewan Association for Safe
Workplaces in Health, its officers, directors, employees and agents do not accept
any liability or responsibility for recourse, claims, causes of action of any kind
whatsoever, in respect of all or any personal harm or injury, injury to others or
property loss arising out of or connected with preparation for, participation in or
application of the procedures in this program.
Acknowledgements
SASWH acknowledges the collaborative effort with developing materials and
securing PPE for the provincial instructor training.
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Saskatchewan’s Ministry of Health and Infection Control Practitioners
(development of Ebola PPE procedures)
3sHealth (securing PPE required)
PPE Trainer’s Guide
Personal Protective Equipment (PPE)
Donning & Doffing
Goals
 Inform workers on the employer legislated responsibilities for PPE and education/training
 Inform workers on their legislated responsibilities and rights
 Train workers on the appropriate donning (putting on) and doffing (removing) of PPE
Legislation
This program meets the minimum requirements of The Occupational Health and Safety
Regulations, 1996, pertaining to the definition of “train”, Regulation 12(c), Regulation 13 and
reviews the three rights of every worker.
Regulation 2(1)eee states:
“Train” means to give information and explanation to a worker with respect to a particular
subject-matter and require a practical demonstration that the worker has acquired knowledge
or skill related to the subject matter;
Regulation 12(c) states:
General duties of employers
(12) The duties of an employer at a place of employment include:
(c) the provision of any information, instruction, training and supervision that is
necessary to protect the health and safety of workers at work;
Regulation 13 states:
A worker shall:
(a) use the safeguards, safety appliances and personal protective equipment
provided in accordance with these regulations and any other regulations made
pursuant to the Act; and
(b) follow the safe work practices and procedures required by or developed
pursuant to these regulations and any other regulations made pursuant to the
Act.
Under the occupational health and safety legislation every worker has three rights.
1. Right to Know the hazards at their workplace, to be trained to recognize them, and to be
trained to protect themselves.
2. Right to Participate in their own safety as well as the safety program in their workplace.
3. Right to Refuse an act or series of acts where the worker has reasonable grounds to
believe that it is unusually dangerous. This is a refusal of an individual worker, not a group of
workers.
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PPE Trainer’s Guide
Fit Testing
N95 respirators are used with Ebola specific PPE donning and doffing procedures. The
employer’s process for fit testing workers is to be followed.
Resources
Resources are available on SASWH’s website (www.saswh.ca) under the Resources tab,
Personal Protective Equipment section. Resources provided are subject to revisions,
enhancements and updates as additional information becomes available.
SASWH recommends that you check this Resource area prior to teaching PPE in the event
revisions to resources are available. SASWH will ensure that PPE Instructors certified are
informed about the most current information as it becomes available; and anticipates instructors
would then notify the trainers in their respective health regions.
Links to video resources would also be available. Videos, or portions of videos, may be used to
enhance the training session. It may be necessary to clarify the information in some videos as it
may not be specific to this training, but could provide a visual on procedures if aligned to this
material.
Additional informational resources may also be available such as posters, Q&A documents,
Ebola information, etc.
Your employer may also have specific information developed and available such as a policy
related to PPE. This would be a valuable resource to share with participants.
PPE Training Resources (Trainer’s Guide, agenda, PowerPoint, evaluation, sign in sheet)
The PPE Trainer’s Guide has been developed to assist trainers with teaching the program in a
classroom setting. This PPE training program is interactive and involves discussion and return
demonstration of each donning and doffing technique. Text that is underlined is provided for
information and guidance when providing general participant sessions. The word (slide) is in the
section heading where a PowerPoint slide aligns with the content of the Trainer’s Guide.
Sample agendas are provided. The times indicated for each agenda item are for the purpose of a
guideline and you can adjust these to fit the group, your teaching style and in consideration of
some discussion on topics. To help you stay on track with the time, you may want to record your
start and end time for each topic listed. You may also need to adjust the times for sessions
depending upon the group size and the level of PPE education/training provided.
The template for the corresponding PowerPoint presentation can be downloaded from SASWH’s
website, under Resources. It can be customized for your session with employer specifics such as
policy, site specific procedures, etc.
Templates for the evaluation form and sign-in sheet are also available. Customize these
documents to suit your employer needs. Employers are to retain a copy of training records for
due diligence in tracking worker training.
If you have any questions about using the resources, contact your PPE instructor or SASWH.
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PPE Trainer’s Guide
Teaching PPE – Donning and Doffing
IMPORTANT! The Lesson Plan includes three different procedures for PPE
Donning and Doffing. Select the lesson plan for the session you are providing and
use the appropriate PPE for demonstration and return demonstration purposes:
 Basic
 Ebola Low Risk
 Ebola High Risk – this also requires a Trained Observer and use of checklists
Recommended class size is one trainer to four participants to accommodate the following
timelines:
Level of PPE training
Basic
Low Level Ebola
High Level Ebola
Theory
30 to 35 minutes
30 to 35 minutes
30 to 35 minutes
Demo/Return Demo/Practice
1 to 1.5 hours
1.5 to 2 hours
3 to 3.5 hours
Total Time
1.5 to 2 hours
2 to 2.5 hours
3.5 to 4 hours
The larger the class the longer the course as each participant must provide a return
demonstration of donning and doffing each piece of PPE. Increasing the class size also
increases the number of trainers in order to adequately observe each participant.
The practice element of donning and doffing PPE must be done slowly and thoroughly.
This program is intended as a classroom facilitated training program. Each participant should
practice donning and doffing two to three times in class, and continue to practice after class.
A trainer is responsible to teach the program and have each participant provide a return
demonstration of the donning and doffing techniques. If a participant does not provide a return
demonstration or does not adequately comprehend the program, their manager/supervisor must
be made aware.
Trainers can be seen as the coach or “go to” person when staff have questions. Unless it is part
of the trainer’s regular job duties, a trainer is not responsible to supervise a participant once they
return to their work area.
If co-teaching a session with another trainer, discuss the topics that each trainer will be teaching
so that the session is a success.
Training Supplies, Equipment & Resources
Along with the Trainer’s Guide, evaluation forms, handouts/pens if used, sign in sheet, and a
waste receptacle for used PPE, the following is a list of PPE supplies needed in order to teach a
session. Use the PPE your employer provides for any specific situation, such as Ebola Virus
Disease. One set of PPE for each participant is preferred especially for items such as the mask.
Sizing of PPE must also be considered to ensure appropriate fit.
Basic PPE
 boot/shoe covers
 gloves
 gowns
 mask/respirator (N95 preferred)
 goggles
 face shield
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PPE Trainer’s Guide
Ebola Specific PPE (as per the Ministry of Health procedures for Low and High Risk Ebola)
Low Risk
 fluid resistant surgical/procedure mask
 nitrile gloves - regular length or
extended length
 level 4 surgical gown with cuffs
 full face shield
High Risk
 knee-high shoe covers
 N95 respirator
 surgical hood
 nitrile gloves - regular and extended length
 level 4 surgical gown with cuffs
 full face shield
 doffing pad (marked Section 1 and Section 2)
IMPORTANT! If healthcare facilities decide to add additional PPE or modify this PPE
guidance, they must consider the risk/benefit of any modification, and train healthcare
workers on correct donning and doffing in the modified procedures.
Park “Aid” (or “Parking Lot”)
As participants have questions, discuss concerns and make suggestions, put the ideas that are
difficult to problem solve during the session on flipchart paper called “Park Aid”. It is not the
trainer’s responsibility to come up with answers to all the problems listed in “Park Aid”. Trainers
may need to take some of the identified problems to management for a solution/response. If the
Park “Aid” is used, explain the purpose to the participants.
Room Layout
The room should have tables and chairs for participants, an area for the supplies and
accommodate space for practice of donning and doffing.
Administrative documents are:
 attendance list/sign in sheet - each participant should sign in as a means of tracking their
attendance (your employer may have a customized form for you to use)
 evaluation form - each participant should complete an evaluation (your employer may
have a customized form for you to use) as this gives you valuable feedback
Evaluation of the training session is important in determining whether you have met the
material’s learning objectives and in adjusting your training session to meet participant needs.
Ask for constructive feedback for the things that you can change. If you are new to facilitating
sessions, remember that your delivery will improve with experience although the content of the
program may not change.
Preparation
The day of the training session can be exciting and may also make you and/or participants
nervous. The best way to deal with nervousness is to take several calming breaths and to repeat
to yourself that everything will go well. Remember, as the facilitator of this material you are the
expert and when faced with a challenging question, give yourself the freedom to say “I’m not
sure, but I can find out the answer and let you know”.
Be well prepared and know your material, each piece of PPE and the donning and doffing
procedure. Use the Trainer’s Guide and resources available.
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PPE Trainer’s Guide
Step by Step Practical Tips
 Be the first one at the training room and be organized (mentally and physically) so that
you can relax and greet participants as they arrive.
 Place a sign near or at the entrance that provides directions to the training room, or
ensure the agency has noted where the session is being held and how to get to the room.
 Set up the laptop and projector and make sure it works.
 Set up your flipcharts, markers, etc., and make sure you have all the supplies and
equipment needed for the training session.
 Get your presentation ready – organize your overheads or get your electronic
presentation up and running.
 Set up your participant tables and organize handouts for each participant, making sure
that all participants have a clear view of flipchart/overheads, etc. Try not to block the view
of visual aids at any time throughout the session (e.g., by a pillar in the room or your
presentation area).
 Check the room temperature and know how to have it adjusted.
 Know where the washrooms, emergency exits, cafeteria, telephones and any other
information required can be located. Briefly review emergency exit procedures with
participants.
 Have each participant sign an attendance list. Ask them to print clearly and legibly as this
will be provided to their employer.
Questions to Ask Yourself
 Did I achieve the learning objectives of the program being taught?
 Would I change the presentation format in any way?
 Did the activities in this session meet the needs of the various learning styles?
 Was there too much or too little of an activity, information, group participation, etc.?
 How can I change things for future training sessions – if I feel I need to?
 Was the material interesting and varied?
 Was it useful to participants and related to the learning objectives?
In your role as a trainer you may want to, or be required to, follow-up with participants and
determine if:
 they have been able to apply what they learned.
 they have used the skills information they obtained during the training.
 the program has been useful to them in their work environment.
In your own assessment, note how the participants reacted to the training session and whether
the content and materials were relevant. Note how you feel about the training session, what you
would change and what went really well.
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PPE Trainer’s Guide
Teaching Adults Effectively
Principles
Adults have a great deal
of first-hand experience.
Application
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Adults want to learn in
the cheapest, easiest
and fastest way.
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Adults compensate for
being slower by being
more accurate. Adults
take errors personally.

Information that conflicts
with what adults believe
is either resisted or
integrated slowly.

The room set-up will
influence learning.
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Ask participants to share experiences, techniques and ideas that
are similar to the ideas being taught.
Use active teaching strategies, for example:
 Demonstration/return demonstration
 Problem solving
 Sharing problems and solutions.
Tell them at the beginning what you plan to teach them. Tell them
at the end what they have learned.
Have a teaching plan and stick to it.
Practice ahead of time using overheads and props.
Finish on time.
Always begin by giving adults a task that is easy to accomplish
(e.g., introducing themselves).
Construct the activities from "easiest" to "most difficult".
Be aware that a successfully managed activity is a great motivator
for learning.
Give participants a chance to apply the new information to practical
situations in their own lives.
Have participants work in pairs or groups so that they learn from
each other, as well as from you, the trainer.
Use a space adequate for the number of participants, equipment
and training aides. Avoid rooms that are too small or even too
large.
Have moveable tables and chairs.
Arrange the tables and chairs so that participants don’t have to
twist/rotate their body to see each other, the instructor and any a/v
presentations.
Practice using audio/visuals.
Adults learn in a variety
of ways.

Use varied teaching approaches, for example:
 lectures
 demonstrations
 case studies
 videos
 role playing.
Seek participants'
opinions.

Use open-ended questions, like:
 Who?
 What?
 When?
 Where?
 How?
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PPE Trainer’s Guide
Lesson Plan for PPE – Donning and Doffing
This section is applicable to all levels of PPE Donning and Doffing
Housekeeping Details (slide) 1-2 minutes
First we have a few housekeeping details:
 Length of session, finishing time
 Washrooms
 Emergency exits/muster point
 Cellular phones, pagers turned off unless absolutely necessary
 other items you want to add such as scent free, smoking area
Welcome & Introduction (slide) 2-3 minutes
Welcome participants and introduce yourself.
This session will be a hands-on learning experience with lots of interactive participation. Ask
questions as we go through the program.
While there is a lot of discussion about current diseases such as Ebola, this session is all about
appropriate donning and doffing procedures for PPE. Donning and doffing is one part of your
employer’s comprehensive infection control program.
Successful completion of this program includes:
 your active involvement in discussion
 return demonstration of donning and doffing techniques
If using SASWH’s evaluation with pre and post session questions, ask participants to complete
the “pre” questions only”. Then put the evaluation to the side as the post questions would be
answered after the session.
ASK:
Are there any questions?
Handouts for Ebola Specific Sessions 1-2 minutes
Have any handouts you wish to include. Explain that handouts are an overview of the information
for the session. They may wish to keep this handy for additional practice, post in the staff area
and refer to it following training.
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Donning and Doffing PPE for Low Risk Ebola
Donning and Doffing PPE for High Risk Ebola and requires a Trained Observer and use
of the Trained Observer Checklists
What You Will Learn (slide) 1-2 minutes
 The employer legislated responsibilities for personal protective equipment and
education/training
 Your legislated responsibilities and rights as a worker
 The appropriate donning (putting on) and doffing (removing) of PPE
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PPE Trainer’s Guide
Legislation (slides)
Saskatchewan’s Occupational Health and Safety Regulations, 1996, 2(1)eee states:
“Train” means to give information and explanation to a worker with respect to a particular
subject-matter and require a practical demonstration that the worker has acquired knowledge
or skill related to the subject matter;
During this session you will need to provide a return demonstration of donning and doffing. This
will show that you have learned the skill.
Regulation 12(c) states:
General duties of employers
(12) The duties of an employer at a place of employment include:
(c) the provision of any information, instruction, training and supervision that is
necessary to protect the health and safety of workers at work;
Providing this training on donning and doffing PPE is an employer’s responsibility.
Regulation 13 states:
A worker shall:
(a) use the safeguards, safety appliances and personal protective equipment
provided in accordance with these regulations and any other regulations made
pursuant to the Act; and
(b) follow the safe work practices and procedures required by or developed
pursuant to these regulations and any other regulations made pursuant to the
Act.
As a worker, you are required to use the PPE provided, and follow safe work practices
and procedures.
Under the occupational health and safety legislation every worker has three rights.
1. Right to Know the hazards at their workplace, to be trained to recognize them, and to be
trained to protect themselves.
2. Right to Participate in their own safety as well as the safety program in their workplace.
3. Right to Refuse an act or series of acts where the worker has reasonable grounds to
believe that it is unusually dangerous. This is a refusal of an individual worker, not a group of
workers.
The next piece is on Accountability. If you are not comfortable speaking to this entire section, you
could invite your manager/supervisor into the session. Plan this ahead of time so you both are
prepared.
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PPE Trainer’s Guide
Accountability (slide) 5-6 minutes
The goal is to help workers understand they are responsible and accountable for their actions.
ASK: What does “accountability” mean to you?
ANSWERS: Give each person the opportunity to give their response(s). You may want to write
the responses on a flipchart and refer back to them as you go through this section.
The general definition of “accountability” includes:
 being bound to give an explanation of your conduct
 being responsible; answerable.
In day to day work, accountability means:
 following the policy
 using the skills you have received in training
 being responsible for the decisions/actions you make at work and even at home
 performing your job duties accurately and appropriately and using your knowledge, skills
and abilities received during training - including making appropriate choice
 asking for help/assistance or additional training
 use equipment safely
 report anything that is unsafe.
As a trainer, some of the things I am accountable for are:
 preparing in advance and being here today to teach the program
 staying up to date with any new material related to PPE
 observing each of you as we work through the donning and doffing process and helping
you to learn
 completing attendance lists, any follow-up required with your manager/supervisor
Everyone is accountable - me, you, your manager/supervisor, VPs, right up to the CEO.
ASK: Can you share some of the areas or ways you are accountable at work and even at home?
ANSWERS: Give each person the opportunity to share. Some answers may include:
 coming to work on time
 wearing appropriate clothing (e.g., PPE, uniform, footwear)
 documenting incidents
 changing the way we work and using the skills we are taught
ASK: How do you think we should be held accountable?
ANSWERS: Some answers may include:
 as per the policy
 performance plan
ASK: Does the employer have an option about following the law?
ANSWER: No. No choice. Not optional.
ASK: Do workers have an option/choice about following the law?
ANSWER: No. The law is the law. What employers have to provide, workers must use.
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PPE Trainer’s Guide
Personal Protective Equipment (slide) 1-2 minutes
The purpose of PPE is to provide protection – not only to the worker but also with eliminating or
managing the risk of transferring a virus to a client or another individual.
PPE covered in today’s session includes: customize this list for your session, including the
PowerPoint slide. You may want to show each piece as you mention it:
 N95 respirator: respirators help stop transmission from you or to you
 Gown: protects your clothing
 Gloves: protects your hands
 Boot/shoe covers: protects your feet/footwear from exposure and reduces transmission of
contaminants that may be on your footwear
 Goggles: provides protection to your eyes
 Face shield: provides protection to your face
 Surgical hood: provides protection to your head and neck
IMPORTANT! If healthcare facilities decide to add additional PPE or modify this PPE
guidance, they must consider the risk/benefit of any modification, and train healthcare
workers on correct donning and doffing in the modified procedures.
Training, Practice, Competence, Observation (slide) 1-2 minutes
The emphasis in this session is on the importance of training, practice, competence and
observation of healthcare workers in correct donning and doffing of PPE selected by the
employer.
Training: this is considered your training session for donning and doffing PPE. Ask questions
if you’re not sure about something.
Practice: we will practice donning and doffing each piece of equipment. Perfect practice
makes perfect. This will take time, we’ll practice very slow and deliberate - this is a task that
we will not rush through. After you leave this session, keep practicing and use another
trained person to observe you.
Competence: this is your “know how”, your ability to use what you will be taught today. So
“know how” to don and doff properly before you leave this session.
Observation: this is where I am going to watch and coach each of you don and doff every
piece of PPE.
ASK:
Are there any questions?
Principles of PPE (slide) 1-2 minutes
There are basic principles to ensure safe and effective PPE use.
Donning
 PPE must be donned correctly in proper order before entry into the patient care area.
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PPE Trainer’s Guide
During Patient Care
 PPE must remain in place and be worn correctly for the duration of exposure to
potentially contaminated areas. PPE should not be adjusted during patient care. Don’t
adjust your eyeglasses, hair, etc. Don’t touch any part of your face.
 Having a “buddy” with you during patient care will help to check for a partial or total
breach in PPE (e.g., gloves separate from sleeves leaving exposed skin, a tear develops
in an outer glove, a needlestick). The healthcare worker must move immediately to the
doffing area to assess the exposure.
Doffing
 The removal of used PPE is a high-risk process that requires a structured procedure, a
trained observer when using High Risk Ebola procedures, and a designated area for
removal to ensure protection.
 PPE must be removed slowly and deliberately in the correct sequence to reduce the
possibility of self-contamination or other exposure viruses, such as Ebola.
Remember! (slide)
 Always move slowly – it is a step by step task
 Do not rush when donning PPE
 Avoid touching PPE once donned
 Avoid touching face, exposed skin
 Do not rush when doffing PPE
 Use appropriate waste receptacle (preferably hands-free) and discard carefully
ASK:
Are there any questions?
The following pages have procedures for Basic PPE, PPE for Low Risk Ebola and PPE for High
Risk Ebola. Select the appropriate procedures for the session you are teaching.
The accompanying PowerPoint has slides for each procedure. You may wish to hide slides that
you are not using.
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PPE Trainer’s Guide
DONNING Personal Protective Equipment - Basic Procedure
IMPORTANT! For Ebola specific training, use Low Risk or High Risk procedures
The following processes are the basic procedures for booties, gowns, gloves, masks, eye
protection and face shields. Demonstrate these techniques and have participants provide return
demonstrations to ensure they understand the procedure. Have equipment samples available so
participants can practice donning and doffing techniques. Fit testing for N95 respirators could be
incorporated into this presentation.
The following is a step-by-step process for donning (putting on) basic PPE.
(slide)
Use the following safe work practices to protect yourself and limit the spread of contamination:
 Keep your hands away from your face and limit the surfaces you touch.
 Change gloves when torn or heavily contaminated.
 Regularly perform hand hygiene. An alcohol based hand rub (ABHR) is the preferred method
to clean hands. If hands look or feel soiled, use soap and water to clean hands.
Donning Sequence (slide)
Proper hand hygiene is first, then followed by:
1. Shoe covers or booties
2. Gown
3. Mask/respirator
4. Goggles/Face Shield
5. Gloves
Donning Techniques demonstrate the steps and participants complete a return demonstration
Step 1: Shoe Covers or Booties
1. All staff should be wearing shoes that are closed (no open heels/toes) and fluid resistant.
2. Support yourself against a clean surface or sit down to apply booties.
3. Avoid touching the bottom of shoes with clean hands.
Step 2: Gown
1. Fully cover your torso from your neck to your knees, arms to the end of your wrists, and wrap
the gown around the back of your torso.
2. Fasten at the back of your neck and at your waist.
Step 3: Mask/Respirator
The following donning techniques are basic and are only intended to provide a basic overview.
Being fit tested will help determine the appropriate mask for you.
1. Secure ties or elastic bands at the middle of the back of your head and at your neck.
2. Fit the flexible band to your nose bridge.
3. Fit snug to your face and below your chin.
4. Fit-check the mask/respirator.
Step 4: Goggles/Face Shield
1. Place over your face and eyes and adjust to fit.
Step 5: Gloves
1. Pull the gloves on and extend each one to cover the wrist portion of your gown.
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PPE Trainer’s Guide
DOFFING Personal Protective Equipment - Basic Procedure
IMPORTANT! For Ebola specific training, use Low Risk or High Risk procedures
The following is a step-by-step process for doffing (taking off) basic PPE.
Use the following safe work practices to protect yourself and limit the spread of contamination:
 Keep your hands away from your face and limit the surfaces you touch.
 Change gloves when torn or heavily contaminated.
 Regularly perform hand hygiene. An alcohol based hand rub (ABHR) is the preferred method
to clean hands. If hands look or feel soiled, use soap and water to clean hands.
Doffing Sequence (slide)
1. Shoe covers or booties
2. Gloves
3. Gown
4. Goggles/face shield
5. Mask/respirator
Proper Hand Hygiene
Doffing Techniques demonstrate the steps and participants complete a return demonstration
Step 1: Shoe covers or Booties. The outside of the shoe covers or booties is considered
contaminated and should not be touched.
1. Pull off carefully starting from heel area, being careful not to touch your shoes.
2. If longer boots are used, undo Velcro strips or straps and pull or peel boots down and away,
touching the outside surface only.
3. Place in appropriate waste receptacle.
Step 2: Gloves. The outside of the gloves is considered contaminated and should not be
touched.
1. Grasp the outside of one gloved hand with the opposite gloved hand and peel off the dirty
glove.
2. Hold the removed glove in gloved hand.
3. Slide fingers of ungloved hand under remaining glove at the wrist.
4. Peel glove off over the first glove so they are being rolled into themselves (this minimizes
contamination of your exposed hands to the outside dirty surface area of the gloves).
5. Place in appropriate waste receptacle.
6. Perform hand hygiene.
Step 3: Gowns. The front and sleeves of a gown are considered contaminated and should
not be touched.
1. Wash your hands.
2. Unfasten ties at neck and waist.
3. Slide two fingers under cuff of gown and pull hand into gown. Using the hand that is covered,
grab the opposite sleeve of gown and pull away from your body and over your hand.
4. Fold the gown inward on to itself and rolling it away from you until it becomes small enough
to discard.
5. Place in appropriate waste receptacle.
6. Perform hand hygiene.
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PPE Trainer’s Guide
Step 4 - Goggles/Face Shields. The front of goggles and face shields are considered
contaminated and should not be touched.
1. Wash your hands.
2. Only handle the earpieces or headband.
3. Place in appropriate waste receptacle.
4. Perform hand hygiene.
Step 5 - Masks/Respirators. The front of a mask/respirator is considered contaminated
and should not be touched.
1. Wash your hands.
2. Re-glove one hand.
3. Remove the mask/respirator without snapping elastic bands by grasping the facepiece with
the gloved hand.
4. Remove the straps as per the manufacturer's guidelines.
5. Once the mask/respirator has been safely removed, place it and the dirty glove into
appropriate waste receptacle.
6. Perform hand hygiene.
Reinforce that this is the current recommended sequence of removal for Basic PPE based upon
best practices and current information.
Summary
Specific steps are required when donning (putting on) and doffing (removing) PPE. There may
be additional specific steps depending on the PPE you are using for the situation.
Infection Control (IC)
There are specific infection control precautions and procedures that healthcare workers are
required to follow. Please refer to/consult the following resources for further information:
1. the approved infection control manual/policies/procedures for your agency/health region;
2. the designated agency/health region IC professional; or
3. your supervisor.
ASK:
Are there any questions?
If PPE basic training is what you are providing, you can then complete the session as indicated
on the last page of the Lesson Plan.
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Facilitator Guidelines for
Training on Donning and Doffing PPE for Ebola Virus Disease (EVD)
IMPORTANT! If healthcare facilities decide to add additional PPE or modify this PPE
guidance, they must consider the risk/benefit of any modification, and train healthcare
workers on correct donning and doffing in the modified procedures.
Use the procedures for donning and doffing PPE for Low Risk Ebola or for donning and doffing
PPE for High Risk Ebola with a Trained Observer. These procedures were developed by
Saskatchewan’s Ministry of Health and Infection Control Practitioners.
IMPORTANT! For High Risk, the Trained Observer is required.
Each step of donning and doffing, as well as the Trained Observer checklists for High Risk, must
be thoroughly reviewed with participants. A return demonstration from each participant, on each
piece of PPE, is required in order to be deemed trained.
Have the donning and doffing procedures in front of you – for either Low Risk or High Risk. Have
the appropriate PPE laid out in order of the procedures – this will help you be organized as you
go through the procedures.
Demonstrate slowly – ensure participants see you from the front, side and back
 you may need to turn around/walk around as you don and doff items.
 have participants stand up and gather around you.
 during your demonstration, ask them if they have any questions.
Key message for all participants: PRACTICE SLOW AND METHODICALLY!!! It is a task that
needs to be done correctly – do not rush!
IMPORTANT! For High Risk, include teaching Trained Observer procedures.
Donning Practice and Return Demonstration - teaching options
Option 1: Complete Process
 demonstrate the appropriate donning process by putting on each piece of PPE as you show it
and say what it is. You’ll be completely donned at the end of the procedures.
 then have each participant don each item while you observe (this is return demonstration).
Your role is to observe each participant complete the process accurately, slowly and
thoroughly. You could:
 have each participant don the equipment one at a time
or
 have a couple of participants don the equipment one piece at a time while the others
watch, coach each other. Repeat this with the rest of the group to ensure everyone
dons each piece of PPE while you observe.
Option 2: Piece by Piece
 demonstrate the appropriate donning process by putting on each piece of PPE as you show it
and say what it is.
 as you demonstrate the appropriate donning processes for each piece of PPE, participants
can also don each piece. Everyone will be completely donned at the end of the procedures.
Observing each person donning is critical.
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PPE Trainer’s Guide
Doffing Practice and Return Demonstration – teaching options
Option 1: Complete Process
 demonstrate the appropriate doffing process by taking off each piece of PPE. You’ll be
completely doffed at the end of the procedures.
 then have each participant doff each item while you observe (this is return demonstration).
Your role is to observe each participant complete the process accurately, slowly and
thoroughly. You could:
 have each participant doff the equipment one at a time
or
 have a couple of participants doff the equipment one piece at a time while the others
watch, coach each other. Repeat this with the rest of the group to ensure everyone
doffs each piece of PPE while you observe.
Option 2: Piece by Piece
 demonstrate the appropriate doffing process by taking off each piece of PPE.
 as you demonstrate the appropriate doffing processes for each piece of PPE, participants
can also doff each piece. Everyone will be completely doffed at the end of the procedures.
Observing each person doffing is critical.
Trained Observer with PPE for High Risk Ebola – teaching options
Each participant has a copy of the Trained Observer checklists.
Option 1: incorporate a role play scenario when teaching donning and doffing PPE for High Risk
Ebola.
 divide participants into pairs
 one participant role plays the healthcare worker; the other role plays the Trained Observer
 as you read aloud the donning (and then doffing) steps, and the Trained Observer follows
their checklist, the healthcare worker dons (and then doffs) the piece of PPE while the
Trained Observer completes their associated task
Option 2: incorporate a role play scenario when teaching donning and doffing PPE for High Risk
Ebola.
 divide participants into pairs
 one participant role plays the healthcare worker; the other role plays the Trained Observer
 as the Trained Observer reads aloud the donning (and then the doffing) steps, the healthcare
worker dons (and then doffs) the piece of PPE while the Trained Observer completes their
associated task
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PPE Trainer’s Guide
DONNING Personal Protective Equipment - *LOW RISK Ebola (slide)
(as per Ministry of Health procedures v3 Oct 2014. HCW=healthcare worker)
*Low Risk – Encounter with a patient suspected to have Ebola Virus Disease who is mildly
symptomatic: mild fever, fatigue, headache, sore throat, muscle pain.
The decision to upgrade to a higher level of protection is based on your assessment of risk in each
patient care situation. If risk is high, use the high risk protocol.
The use of a trained observer is not required for a low risk encounter; however, HCWs are
encouraged to request assistance, if needed. The trained observer checklist for donning PPE is not
required for a low risk encounter.
Ensure you are signed into the log book prior to entering patient room.
Move slowly; do not rush, when putting on PPE before entering the patient room.
1. Hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
2. Surgical gown
Gown should be rated as Level 4 for moderate to high level of
fluid resistance
• Gown is securely fastened at the neck, waist, and back using all
Velcro/ties provided
3. Mask
Fluid resistant surgical/procedure mask
• Place mask over nose, mouth, and chin
• Secure ties or loops
• Adjust flexible nose piece over the bridge of your nose using
both hands
1.
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PPE Trainer’s Guide
4. Full face shield
• Place face shield over the mask
• Ensure there is an overlap to protect the forehead
5. Nitrile gloves
Single glove provides adequate protection for low risk
encounter
• Either regular length or extended length nitrile gloves
• Pull gloves over the cuffs of the gown
• Inspect for tears
6. While wearing PPE
• Avoid touching your face or adjusting PPE once in the client care
environment
• Minimize contact with contaminated environmental surfaces
• Should the risk encounter change while providing patient care,
the HCW should leave the patient area, safely remove all
personal protective equipment, and begin using the high risk
protocol for further patient encounters
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PPE Trainer’s Guide
DOFFING Personal Protective Equipment - *LOW RISK Ebola (slide)
(as per Ministry of Health procedures v3 Oct 2014. HCW=healthcare worker)
*Low Risk – Encounter with a patient suspected to have Ebola Virus Disease who is mildly
symptomatic: mild fever, fatigue, headache, sore throat, muscle pain.
The use of a trained observer is not required for a low risk encounter; however, HCWs are
encouraged to request assistance, if needed. The trained observer checklist for doffing PPE is not
required for a low risk encounter.
Personal protective equipment should be removed in a designated doffing area (e.g., anteroom or in
patient’s room near the door) and discarded into an appropriate waste receptacle.
Remove personal protective equipment slowly and carefully.
1. Disinfect gloves
• Clean gloves using a hospital grade disinfectant wipe before
touching the door handle
2. Inspect
• Inspect PPE for visible contamination or tears
• Remove any obvious contamination with a hospital grade
disinfectant wipe
3. Remove gloves
• Grasp outside edge of glove near the wrist and peel away, rolling
the glove inside out
• Slide 1 or 2 fingers under the wrist of the remaining glove and
peel away
• Discard immediately into waste
4. Remove gown
• Remove gown in a manner that prevents contamination of
clothing and skin
• Carefully unfasten ties
• Slide 2 fingers under cuff of gown and pull hand into gown.
Using the hand that is covered, grab the opposite sleeve of gown
and pull away from body over hand. Continue folding the gown
inward on to itself and rolling it away from you until it becomes
small enough to discard
• Place into waste receptacle
5. Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Use soap and water if hands are visibly soiled
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PPE Trainer’s Guide
6. Remove face shield
2. 7. Remove mask
3.
8. Perform hand hygiene
• The front of the face shield is considered contaminated
• Handle only by the rear strap and pull it up and over the head
gently, allowing the face shield to fall forward
• Place in waste receptacle
• Ties/straps are considered “clean” and may be touched
with hands
• Untie the bottom tie first, then the top or grasp straps with
both hands
• Pull forward off the head, bending forward to allow mask to fall
away from face
• Place in waste receptacle
• Alcohol-based hand rub (ABHR) is preferred
• Use soap and water if hands are visibly soiled
If PPE Ebola Low Risk training is what you are providing, you can then complete the session as
indicated on the last page of the Lesson Plan.
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PPE Trainer’s Guide
Trained Observer for High Risk Ebola (slides)
The following information for Trained Observer is obtained from the Centers for Disease Control
and Prevention, October 20, 2014.
Review this information with the group so they understand a Trained Observer is required when
utilizing the High Risk Ebola procedures. Explain that this role will be included in the practice.
A Trained Observer is required for donning and doffing procedures for High Risk Ebola. During
this training each of you will role-play the healthcare worker and the observer. Following
successful completion of this session, participants would be considered a Trained Observer there is not a separate session for observers.
The sequence and actions involved in each donning and doffing step are critical to avoiding
exposure. This requires active participation by a trained observer. The trained observer:
 is a dedicated individual with the sole responsibility of ensuring adherence to the entire
donning and doffing process
 will be knowledgeable about all PPE recommended in the facility’s protocol and the
correct donning and doffing procedures, including disposal of used PPE
 will read aloud to the healthcare worker each step in the procedure checklist and visually
confirm and document that the step has been completed correctly
 will ensure the healthcare worker avoids touching their face/exposed skin during the
donning and doffing procedure
 will be qualified to provide guidance and technique recommendations to the healthcare
worker - this is achieved during this training session
 will monitor and document successful donning and doffing procedures, providing
immediate corrective instruction if the healthcare worker is not following the
recommended steps
 inspects PPE for gaps and adjusts if necessary
 conducts range of motion activities to ensure PPE stays intact and the healthcare worker
is comfortable
 should know the exposure management plan in the event of an unintentional break in
procedure
Additional Responsibilities for the Trained Observer
The employer may assign responsibilities such as:
 ensuring adequate PPE supplies are available in the donning area and the procedure to
secure these supplies
 ensuring the donning and doffing areas are clean (e.g., wiping down chairs) including the
appropriate training on cleaning
Recommended PPE for Trained Observer
Trained observers should don and doff selected PPE according to same procedures for High
Risk Ebola. The trained observer should not enter the room of a patient with Ebola, but will be
present to observe and assist with donning and doffing of specific components of PPE. The
observer should not participate in any Ebola patient care activities while conducting
observations.
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PPE Trainer’s Guide
The following PPE are recommended for trained observers:
 Single-use (disposable) fluid-resistant or impermeable gown that extends to at least midcalf
 Single-use (disposable) full face shield
 Single-use (disposable) nitrile gloves with extended cuffs. Two pairs of gloves should be
worn. At a minimum, outer gloves should have extended cuffs.
 Single-use (disposable) fluid-resistant or impermeable shoe covers. Shoe covers should
allow for ease of movement and not present a slip hazard to the worker.
You can demonstrate the donning and doffing procedures now and have participants provide a
return demonstration, or you can incorporate this when you complete the donning and doffing
procedures for High Risk Ebola.
Donning Sequence for PPE for Trained Observer (double glove sequence*): (slide)
1. Hand hygiene
2. Shoe/boot covers
3. Hand hygiene
4. Nitrile gloves (under the cuff of the gown)
5. Surgical gown
6. Full face shield
7. Extended cuff nitrile gloves (over the cuff of the gown)
8. Inspection
Doffing Sequence for PPE for Trained Observer (double glove sequence*): (slide)
1. Remove outer gloves
2. Disinfect inner gloves
3. Remove surgical gown
4. Remove shoe/boot covers
5. Remove inner gloves
6. Hand hygiene
7. Don new gloves
8. Remove full face shield
9. Remove gloves
10. Hand hygiene
*if not using double gloves, adjust doffing sequence accordingly
Go through the Trained Observer checklists with the group before proceeding with the practice.
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PPE Trainer’s Guide
Trained Observer Checklist for PPE Donning - High Risk1
(as per Ministry of Health procedures v1A Nov 18/14. HCW=healthcare worker; TO=trained observer)
1High risk symptoms: Bleeding or uncontrolled diarrhea or uncontrolled vomiting
High risk procedures: Aerosol generating medical procedures (AGMPs), CPR, central line insertion,
procedures that result in copious amounts of body fluid contamination
Done
1. Trained Observer (TO) is available and has changed into required PPE:
a. Surgical gown, shoe covers, face shield and gloves
2. TO is ready to monitor the steps of the PPE donning checklist and will assist healthcare
worker (HCW) as required
3. HCW has completed the following pre-donning activities:
a. Changed from personal clothing to scrubs and washable footwear
b. Removed all personal items (e.g., jewelry, watches, cell phones, pagers, pens,
lanyards, stethoscopes)
c. Signed into log book
d. Hydrated and recently used the washroom
e. Tied or pulled longer hair back
f. Ensured all required PPE are available in the sizing appropriate for HCW fit
4. Perform hand hygiene
5. Put on boot covers – sit on clean chair or stool, if available
a. Place boot cover on toes of foot and pull up leg
6. Perform Hand Hygiene
7. Put on N95 respirator:
a. Place over the nose, mouth and chin
b. Flexible nose piece is fitted over bridge of nose
c. Secure on head with elastics: bottom elastic first at the base of the neck, then top
elastic at the crown of your head
d. HCW performs seal-check
8. Put on inner gloves (regular or extended length nitrile)
9. Put on surgical gown:
a. Gown is securely fastened at the neck, waist and back using all Velcro/ties provided
b. TO may assist with ties if required
10. Put on surgical hood:
a. Ensure hood fits over the N95 respirator and personal glasses if wearing
b. Hood should cover all of the hair and the ears, and extend past the neck to the
shoulders
b. TO will check that hood completely covers the ears and neck area
11. Put on face shield over the N95 respirator and surgical hood:
a. Adjust to fit
b. Ensure there is an overlap to protect the forehead
12. Put on the outer 2nd pair gloves:
a. Long cuff nitrile gloves that fit over the cuff of the gown
13. TO verifies that all pieces of PPE are in place and all skin areas are covered
14. HCW reaches and bends over to ensure PPE stays in place while in motion
Date/Time
Healthcare Worker
Trained Observer
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PPE Trainer’s Guide
Trained Observer Checklist for PPE Doffing - High Risk1
(as per Ministry of Health procedures v1A Nov 21/14. HCW=healthcare worker; TO=trained observer)
1High risk symptoms: Bleeding or uncontrolled diarrhea or uncontrolled vomiting
High risk procedures: Aerosol generating medical procedures (AGMPs), CPR, central line insertion,
procedures that result in copious amounts of body fluid contamination
Done
1. Trained observer (TO) is available to supervise proper PPE removal by reading aloud each
step of the procedure
2. TO has on a surgical gown, shoe covers, face shield and gloves
3. TO will prepare a doffing pad that is marked section 1 and section 2 and ensure a chair is
available
4. Prior to removal of PPE, TO will remind the healthcare worker (HCW) to avoid reflexive
actions that may put them at risk, such as touching their face, and to perform each step
done slowly and carefully
5. HCW uses a hospital grade disinfectant wipe to clean outer gloves prior to opening the
door to patient room
6. Using a new disinfectant wipe, the healthcare worker will clean the door handle before
opening the door
7. HCW steps out of room onto section 1 of the doffing pad
8. TO visually inspects HCW’s PPE for visible signs of contamination, cuts or tears before
doffing process is started. If any PPE is potentially contaminated, HCW to clean and
disinfect area using a hospital grade disinfectant wipe
9. If apron was used, HCW to remove carefully to prevent contact with outside of apron
10. HCW removes outer glove carefully to minimize contact with inner gloves:
a. Grasp outside edge of glove near the wrist and peel away, rolling the glove inside-out
b. Slide 1 or 2 fingers under the wrist of remaining glove and peel away
c. Gloves are discarded into waste receptacle
11. HCW performs inner glove disinfection with hospital grade disinfectant wipe
12. Gently remove gown in manner that avoids contamination:
a. Trained observer will carefully put gloved hands under the back of the hood to
unfasten top tie, then undo the outside waist tie, followed by the inside waist tie
b. HCW will slide 2 fingers under cuff of gown and pull hand into gown. Using the hand
that is covered, grab the opposite sleeve of gown and pull away from body over hand.
Continue folding the gown inward on to itself and rolling it away from you until it
becomes small enough to discard
c. Place into waste receptacle
13. If chair is available,
a. Remove boot covers one at a time by rolling down and outward, lifting your heel first
and then your toes
b. Step out of the boot covers one at a time onto section 2 of the doffing pad
c. Trained observer will discard boot covers into waste receptacle
If chair is not available,
a. HCW will roll the top of the boot covers out and down, and the trained observer can
help pull the boot covers down and hold while the HCW steps on to section 2 of the
doffing pad
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PPE Trainer’s Guide
14. HCW removes inner gloves and TO removes gloves in a manner that avoids contamination
of hands:
a. Grasp outside edge of glove near the wrist and peel away, rolling the glove inside-out
b. Slide 1 or 2 fingers under the wrist of remaining glove and peel away
c. Gloves are discarded into waste receptacle
15. HCW and TO perform hand hygiene with hand sanitizer
16. When hands are dry, both HCW and TO put on a new pair of gloves
17. HCW removes the face shield:
a. The front of face shield is considered contaminated
b. Handle only by the rear strap and pull it up and over the head gently, allowing the face
shield to fall forward.
c. Place in waste receptacle
18. HCW removes gloves in a manner that avoids contamination:
a. Grasp outside edge of glove near the wrist and peel away, rolling the glove inside-out
b. Slide 1 or 2 fingers under the wrist of remaining glove and peel away
c. Gloves are discarded into waste receptacle
19. HCW performs hand hygiene with hand sanitizer
20. When hands are dry, HCW to put on new pair of gloves
21. HCW removes surgical hood:
a. Using their dominant hand, HCW will grasp the top point of the hood
b. Using their non-dominant hand, HCW will hold the bottom middle of the hood to
stabilize motion and keep it from catching on the N95 respirator (and glasses if
wearing) during removal.
c. Bending head slightly forward, HCW will close eyes and pull hood forward and up, off
their head in a slow controlled motion.
d. Open eyes and place hood in waste receptacle
22. HCW removes gloves in a manner that avoids contamination:
a. Grasp outside edge of glove near the wrist and peel away, rolling the glove inside-out
b. Slide 1 or 2 fingers under the wrist of remaining glove and peel away
c. Gloves are discarded into waste receptacle
23. HCW performs hand hygiene with hand sanitizer
24. HCW removes the N95 respirator:
a. The front of the respirator is considered contaminated
b. Lift the bottom elastic up and over your head first, then the top elastic up and over
your head
c. Pull forward off the head, bending forward slightly to allow respirator to fall away
from face
d. Place respirator carefully into waste receptacle
25. HCW performs hand hygiene with hand sanitizer
26. When hands are dry, HCW to put on a new pair of gloves
27. If a second clean chair is available,
a. HCW sits on chair and uses a hospital grade disinfectant wipe to clean the top, sides
and bottom of each shoe (one wipe for each shoe)
b. As each shoe is cleaned, the HCW steps off the doffing pad on to the floor
If second chair is not available,
a. TO will use a hospital grade disinfectant wipe to clean the top, sides, and bottom of
each shoe
b. As each shoe is cleaned, the HCW steps off the doffing pad on to the floor
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PPE Trainer’s Guide
28. HCW removes gloves in a manner that avoids contamination:
a. Grasp outside edge of glove near the wrist and peel away, rolling the glove inside-out
b. Slide 1 or 2 fingers under the wrist of remaining glove and peel away
c. Gloves are discarded into waste receptacle
29. HCW performs hand hygiene with hand sanitizer
30. TO rolls up doffing pad and places in waste receptacle
31. TO removes gloves in a manner that avoids contamination:
a. Grasp outside edge of glove near the wrist and peel away, rolling the glove inside-out
b. Slide 1 or 2 fingers under the wrist of remaining glove and peel away
c. Gloves are discarded into waste receptacle
32. TO performs hand hygiene with hand sanitizer
33. If shift is over, proceed to change area to remove scrubs and have a shower if that is the
facility protocol
Date/Time
Healthcare Worker
Trained Observer
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DONNING Personal Protective Equipment - *HIGH RISK Ebola (slides)
(as per Ministry of Health procedures v1A Nov 18/14. HCW=healthcare worker; TO=trained observer)
*High risk:
Patient is confirmed to have Ebola Virus Disease
OR
Patient is suspected to have Ebola Virus Disease
AND
 has high risk symptoms such as bleeding or uncontrolled diarrhea or uncontrolled vomiting;
or
 is unstable and requires a high risk procedure such as an aerosol generating medical
procedure (includes intubation, open respiratory/airway suctioning, high-frequency
oscillatory ventilation, nebulized therapy, non-invasive positive pressure ventilation),
cardiopulmonary resuscitation, central line insertion, or any procedure that could
potentially result in copious amounts of body fluid generation or exposure
PPE Storage and Donning Area
 An area outside of the patient room (e.g., nearby vacant patient room or a marked area in
the hallway outside the patient room) where clean PPE is stored and where healthcare
workers (HCW) can don PPE under the guidance of a trained observer before entering the
patient room
 Post appropriate signage indicating room designation and purpose
Pre-Donning Activities
 Ensure that all required personal protective equipment and supplies are available and in
the size required for the healthcare worker
 Ensure you are signed into log book
 Remove all personal items (i.e. jewelry, watches, cell phones, lanyards, pagers, pens)
 Ensure longer hair is tied back
 Remove personal clothing and change into scrubs and dedicated washable shoes (fluid
resistant footwear-closed toe and heels, plastic or rubber soles)
 Hydrate (no drinking or eating is allowed in patient care area)
 Ensure trained observer is available to monitor, assist (if required), and document the steps
of the donning checklist with you
 Ensure trained observer document the steps of the donning checklist with you
Trained observer PPE
 The trained observer will don surgical gown, shoe covers, face shield, and gloves
*If using the high risk PPE donning protocol, you must ensure that a trained observer is
present to monitor PPE donning and to document the steps on the PPE donning checklist*
Move slowly; do not rush, when putting on PPE before entering the patient room
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PPE Trainer’s Guide
1. Hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
2. Knee high boot covers
• Sit on a clean chair, if available
• Place boot cover on toes of foot and pull up
3. Hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
4. N95 respirator
Use your appropriate fit-tested size
• Place over nose, mouth and chin
• Flexible nose piece is fitted over bridge of nose
• Secure on head with elastics: bottom elastic first at the base of
the neck, then top elastic at the crown of your head
• Perform a seal-check
5. Nitrile gloves
• Either regular length or extended length nitrile gloves
• First set of gloves worn under gown cuffs
• Inspect for tears
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PPE Trainer’s Guide
6. Surgical gown
Gown should be rated as Level 4 for moderate to high level of
fluid resistance
• Ensure gown is large enough to allow unrestricted movement
• Gown is securely fastened at the neck, waist, and back using all
Velcro/ties provided
• Trained observer may assist with ties, if required
• Ensure inner gloves are tucked under the sleeve of the gown
7. Apron (if used)
8. Surgical Hood
If additional protection against copious body fluids is required
• Ensure hood fits overs the N95 respirator and glasses if wearing
• Hood should cover all of the hair and the ears, and extends past
the neck to the shoulders
• Trained observer will check that hood completely covers the
ears and neck
9. Full face shield
• Place face shield over the N95 respirator and surgical hood
• Adjust to fit
• Ensure there is an overlap to protect the forehead
10. Extended cuff nitrile
gloves
• Second set of gloves worn over gown cuffs
• Inspect for tears
11. Inspection
• Trained observer inspects PPE for gaps and adjusts if necessary
• Conduct range of motion activities (e.g., move your arms, legs
and neck) to ensure PPE stays intact. The goal is for the PPE to
be secure and the staff care provider to be comfortable
• Avoid touching your face or adjusting PPE once in the patient
care environment
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DOFFING Personal Protective Equipment - *HIGH RISK Ebola (slide)
(as per Ministry of Health procedures v1A Nov 21/14. HCW=healthcare worker; TO=trained observer)
*High risk:
Patient is confirmed to have Ebola Virus Disease
OR
Patient is suspected to have Ebola Virus Disease
AND
 has high risk symptoms such as bleeding or uncontrolled diarrhea or uncontrolled vomiting;
or
 is unstable and requires a high risk procedure such as an aerosol generating medical
procedure (includes intubation, open respiratory/airway suctioning, high-frequency
oscillatory ventilation, nebulized therapy, non-invasive positive pressure ventilation),
cardiopulmonary resuscitation, central line insertion, or any procedure that could
potentially result in copious amounts of body fluid generation or exposure
PPE Doffing Area
 Designate an area in close proximity to the patient room (e.g., anteroom or adjacent vacant
room) that is separate from the clean area where healthcare workers (HCWs) leaving the
patient’s room can doff and discard their PPE
 Alternatively, some steps of the PPE removal process may be performed in a clearly
designated area of the patient’s room near the door, which ensures that all doffing steps
can be seen and supervised by the trained observer (e.g., through a window so that the
instructions of the trained observer can still be heard)
 Provide supplies for disinfection of PPE (hospital grade approved disinfectant wipes) and
for hand hygiene
 Provide a space for sitting, parallel to the doffing pad, that can be easily cleaned and
disinfected, where the HCW can remove boot covers
 Provide leak-proof infectious waste containers for discarding used PPE
 If a hallway is being used outside the patient room, construct physical barriers to close
hallway to traffic (thereby creating an anteroom)
 Post appropriate signage indicating room designation and purpose
Pre-Doffing Activities (HCW)
 Ensure the trained observer is available to monitor, assist (where required), and document
the steps of the PPE doffing checklist with you
Pre-Doffing Activities (trained observer)
 Don shoe covers, gown, face shield, and gloves to assist HCW with removal of PPE
 Prepare a doffing pad that is marked section 1 and section 2
 Read aloud each step of the PPE doffing procedure to the HCW and provide reminders to
avoid reflexive actions that may put them at risk, such as touching their face
PPE items shall be removed slowly and carefully and discarded one piece at a time in a handsfree waste receptacle
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PPE Trainer’s Guide
1. Disinfect outer gloves
• Use a hospital grade disinfect wipe to clean outer
gloves prior to opening the door to the patient room
2. Clean door handle
• Use a new hospital grade disinfectant wipe to clean the door
handle before opening the door
3. Inspect
• HCW steps out of the patient room onto section 1 of the doffing
pad
• Trained observer visually inspects PPE for visible contamination
or tears before doffing process is started
• If any PPE appears contaminated, HCW will clean and disinfect
area using a hospital grade disinfectant wipe
4. Remove outer gloves
• Minimize direct contact with inner gloves
• Grasp outside edge of glove near the wrist and peel away, rolling
the glove inside out
• Slide 1 or 2 fingers under the wrist of the remaining glove and
peel away
• Discard immediately into waste receptacle
5. Disinfect inner glove
• Use a hospital grade disinfectant wipe to clean inner gloves
6. Remove gown
• Remove gown in a manner that prevents contamination of
clothing and skin
• Trained observer will carefully put gloved hand under the back of
the hood to unfasten top tie first, then outside waist tie, then
inside waist tie
• HCW will slide 2 fingers under cuff of gown and pull hand into
gown. Using the hand that is covered, grab the opposite sleeve
of gown
and pull away from body over hand. Continue folding the gown
inward on to itself and rolling it away from you until it becomes
small enough to discard
• Place into waste receptacle
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PPE Trainer’s Guide
7. Remove knee high boot
covers
• Sit on a clean chair (if available)
• Remove boot covers one at a time by rolling down and outward,
lifting your heel first and then your toes
• Step out of the boot covers one at a time onto section 2 of the
doffing pad
• Trained observer will discard boot covers into waste receptacle
• If chair is not available, then the HCW will roll the top of the
boot covers out and down, and the trained observer can help
pull the boot covers down and hold while the HCW steps on to
section 2 of the doffing pad
8. Remove inner gloves
• Grasp outside edge of glove near the wrist and peel away, rolling
the glove inside out
• Slide 1 or 2 fingers under the wrist of the remaining glove and
peel away
• Discard immediately into waste
9. Perform hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
10. Put on new gloves
• When hands are dry, put on a new pair of gloves
11. Remove face shield
• The front of the face shield is considered contaminated
• Handle only by the rear strap and pull it up and over the head
gently, allowing the face shield to fall forward
• Place in waste receptacle
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PPE Trainer’s Guide
12. Remove gloves
• Grasp outside edge of glove near the wrist and peel away, rolling
the glove inside out
• Slide 1 or 2 fingers under the wrist of the remaining glove and
peel away
• Discard immediately into waste
13. Perform hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
14. Put on new gloves
• When hands are dry, put on a new pair of gloves
15. Remove surgical hood
• Grasp the top point of the surgical hood with dominant hand and
the bottom middle of hood with non-dominant hand
• Bend head slightly forward, close your eyes
• Pull hood forward and off your head in a slow controlled motion,
(Non-dominant hand to assist hood over N95 respirator)
• Place hood carefully in waste receptacle
16. Remove gloves
• Grasp outside edge of glove near the wrist and peel away, rolling
the glove inside out
• Slide 1 or 2 fingers under the wrist of the remaining glove and
peel away
• Discard immediately into waste receptacle
17. Perform hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
18. Remove N95 respirator
• The front of the respirator is considered contaminated
• Lift the bottom elastic over your head first, then the top elastic
up and over your head
• Pull forward off the head bending forward to allow respirator to
fall away from the face
• Place respirator carefully into waste receptacle
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PPE Trainer’s Guide
19. Perform hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
20. Put on new gloves
• When hands are dry, put on a new pair of gloves
21. Clean shoes
• If a second chair is available, HCW may sit and clean the tops,
sides, and bottoms of each shoe using hospital grade disinfectant
wipes (use one wipe for each shoe)
• If a second chair is not available, the trained observer will wipe
the top, sides, and bottoms of each shoe
• As each shoe is cleaned, the HCW steps off the doffing pad on to
the floor
22. Remove doffing pad
• Trained observer rolls up doffing pad and places in waste
receptacle
23. Remove gloves
• Grasp outside edge of glove near the wrist and peel away, rolling
the glove inside out
• Slide 1 or 2 fingers under the wrist of the remaining glove and
peel away
• Discard immediately into waste
24. Perform hand hygiene
• Perform hand hygiene
• Alcohol-based hand rub (ABHR) is preferred
• Soap and water is used when hands are visibly soiled
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PPE Trainer’s Guide
To Protect Yourself, You Can: (slide) 1-2 minutes
 Ask for training on PPE
 Use the appropriate PPE
 Keep yourself current on PPE
 Practice - perfect practice makes perfect
 Know your employer’s current policy and procedures
 …
Bringing it All Together (slide) 1-2 minutes
 PPE will be provided by the employer
 Staff will be trained on appropriate donning and doffing techniques
 Follow guidelines in place; keep your documents handy for reference
 Ask for help if you need it
 Buddy up - have a trained worker observe you and do the same for them - coach and
mentor each other

ASK:
Are there any questions?
Evaluations 1-2 minutes
Ask participants to complete the “after the session” and other questions on the evaluation and
hand it back in to you before leaving. The employer will need a copy of the sign in sheet in order
to document and record training received by staff.
Thank participants for coming…
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