UNIVERSIDAD DE ZAMBOANGA
SCHOOL OF ALLIED MEDICINE
BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY
Donning and Doffing of PPE
Name:_________________________ Rating:_________
Year and Section:______________ Date:___________
0- Not Observed
1- Performance unacceptable (Frequently omits major steps)
2- Performance needs improvement (Occasionally missed some but major procedure)
3- Performance acceptable (Performed major steps of procedure correctly)
4- Competent (All major & minor steps of the procedure were performed precisely)
4 3 2 1 0 Score
I. KNOWLEDGE AND ATTITUDE
1. Proper Hand hygiene
2. Proper tying hair and wearing of head cover
3. Proper way of putting on PPE
4. Follow correct sequence of Donning and Doffing of PPE
5. Perform procedure with ease, confidence and enthusiasm
II. DONNING: TECHNICAL SKILLS
A. HAND HYGIENE
1.Prepare all materials and equipment within easy reach
2. Wash hand with water and soap for 40-60 seconds.
Scrub all surfaces of the hands and wrist:
a. Palms and back of hands
b. Fingers and surface between, under and around all nail
surfaces
c. Wrists (3 to 4 inches above the hands)
3. Dry hands and wrist thoroughly with a clean towel or tissue.
4. Turn off the faucet with the towel/ tissue used to dry the
hands. Discard tissue in a waste container
5. Alcohol based hand rub; Rub hands for 20-30 seconds.
Scrub all surfaces of the hands and wrist:
a. Palms and back of hands
b. Fingers and surface between, under and around all nail
surfaces
c. Wrists (3 to 4 inches above the hands)
B. GOWN
1. Put on gown properly; Fully cover torso from neck to knees,
arms to the end of wrist, and wrap around the back.
2. Fasten in back of neck and wrist. Secure gown is properly
worn.
C. MASK OR RESPIRATOR
1. Put on mask properly. Secure ties or elastic bands at middle
of head and neck.
2. Fit flexible band to nose bride. Fit snug to face and below
chin. Be sure not to touch the front of mask and respirator.
3. Fit check respirator. Be sure not to touch the front of mask to
avoid contamination
D. GOOGLES OR FACE SHIELD
1. Place over face and eyes and adjust to fit. Place the head
cover. No hair must be exposed. Properly covered.
E. GLOVES
1. Lift right glove by grasping the inside of the cuff with left
hand.
2. Slide right hand into glove without touching the gown or the
outside of the glove. Do not adjust glove of cuff until both gloves
are on
3. Ensure glove is placed over the cuff of the gown and no skin
is exposed.
DONNING TOTAL POINTS
UNIVERSIDAD DE ZAMBOANGA
SCHOOL OF ALLIED MEDICINE
BACHELOR OF SCIENCE IN MEDICAL TECHNOLOGY
Donning and Doffing of PPE
III. DOFFING: TECHNICAL SKILLS
A. GLOVES
1. Using a gloved hand, grasp the palm area of the other
gloved hand and peel off the first glove.
2. Hold removed glove in gloved hand.
3. Slide fingers of ungloved hand under remaining glove at wrist
and peel off second glove over first glove.
4. Discard gloves in a waste container.
B. GOWN
1. Unfasten gown ties, taking care that sleeves don’t contact
your body when reaching the ties.
2. Pull gown away from neck and shoulders, touching inside of
the gown only. Turn gown inside out.
3. Fold or roll into a bundle and discard in a waste container.
C. HAND HYGIENE
1. Alcohol based hand rub; Rub hands for 20-30 seconds.
Scrub all surfaces of the hands and wrist:
a. Palms and back of hands
b. Fingers and surface between, under and around all nail
surfaces
c. Wrists (3 to 4 inches above the hands)
D. GOOGLES OR FACE SHIELD AND HEAD COVER
1. Remove head cover
2. Remove googles or face shield from the back by lifting head
band or ear pieces. If reusable, place in designated receptacle for
reprocessing. Otherwise, discard in a waste container.
E. MASK OR RESPIRATOR
1. Grasp bottom ties or elastics of the mask/respirator, then the
ones at the top and remove without touching the front.
2. Discard in the waste container.
F. HAND HYGIENE
1. Wash hand with water and soap for 40-60 seconds.
Scrub all surfaces of the hands and wrist:
a. Palms and back of hands
b. Fingers and surface between, under and around all nail
surfaces
c. Wrists (3 to 4 inches above the hands)
2. Dry hands and wrist thoroughly with a clean towel or tissue.
3. Turn off the faucet with the towel/ tissue used to dry the
hands. Discard tissue in a waste container
4. Alcohol based hand rub; Rub hands for 20-30 seconds.
Scrub all surfaces of the hands and wrist:
a. Palms and back of hands
b. Fingers and surface between, under and around all nail
surfaces
c. Wrists (3 to 4 inches above the hands)
IV. ATTITUDE
1. Perform procedure with ease, confidence and enthusiasm
DOFFING TOTAL POINTS
COMMENTS
____________________ _____________________ PASS / FAIL
Instructor’s Signature Student’s Signature
