Study guide
4.3 PPE Selection, Donning, Doffing, & Safety
CBIC Associate Infection Prevention and Control a-IPC
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1 Chapter 1: Introduction & Exam Overview
1.1 About the CBIC a-IPC Certification 1.2 Exam Format, Scoring, & Logistics 1.3 Effective Study Strategies & Preparation Plan
2 Chapter 2: Processes to Identify Infectious Diseases
2.1 Chain of Infection & Pathogen Characteristics 2.2 Diagnostic & Laboratory Testing in IPC 2.3 Identifying Healthcare-Associated Infection Syndromes 2.4 Specimen Collection, Handling, Storage, & Transport 2.5 Colonization, Infection, Contamination, & Pseudo-Infection 2.6 Prophylactic, Empiric, & Therapeutic Antimicrobial Use 2.7 Host Risk Factors & Emerging Infectious Disease Threats
3 Chapter 3: Surveillance and Epidemiologic Investigation
3.1 Surveillance Methods & Program Design 3.2 Epidemiological Calculations & Rate Metrics 3.3 Outbreak Investigation Protocols & Epidemic Curves 3.4 NHSN Definitions & Standardized Infection Ratios (SIR) 3.5 Descriptive Statistics & Presenting Surveillance Data 3.6 Surveillance Across the Care Continuum 3.7 Notifiable Disease Reporting, Data Sources, & Registries 3.8 Data Validation & Surveillance Program Evaluation 3.9 Outbreak Control Measures, Environmental Sampling, & Reporting
4 Chapter 4: Preventing and Controlling Transmission
4.1 Standard Precautions & Hand Hygiene Guidelines 4.2 Transmission-Based Precautions & Isolation Protocols 4.3 PPE Selection, Donning, Doffing, & Safety 4.4 Safe Injection Practices & Medication Preparation 4.5 Patient-Care Equipment & Point-of-Care Device Handling 4.6 Emergency Preparedness & the Infection Preventionist's Disaster Role 4.7 Bioterrorism, Special Pathogens, & Community Response Planning
5 Chapter 5: Environment of Care
5.1 Environmental Cleaning & Surface Disinfection 5.2 Water Utilities, Air Handling, & Building Systems 5.3 Construction, Renovation, & Infection Control Risk Assessment (ICRA) 5.4 Laundry, Linen, Waste Management, & Food Safety 5.5 Product Recalls, Supply Chain Monitoring, & Device Incident Reporting
6 Chapter 6: Cleaning, Disinfection, and Sterilization of Medical Devices
6.1 Spaulding Classification System 6.2 Reprocessing Steps & High-Level Disinfection (HLD) 6.3 Sterilization Methods, Monitoring, & Quality Assurance 6.4 Single-Use Devices, Outsourced Reprocessing, & IFU Review 6.5 Reprocessing Failure Investigation & Patient Notification
7 Chapter 7: Employee and Occupational Health
7.1 Occupational Exposures & Post-Exposure Prophylaxis 7.2 Healthcare Personnel Immunizations & Screening 7.3 Work Restrictions & Fit-for-Duty Evaluations 7.4 Sharps Injury Prevention, Product Sensitivities, & Alternatives
8 Chapter 8: Management, Communication, and Antimicrobial Stewardship
8.1 IPC Program Governance, Policies, & Accreditation 8.2 Interdisciplinary Collaboration & Crisis Communication 8.3 Antimicrobial Stewardship Principles & Interventions 8.4 Chain of Command, Resource Advocacy, & the Business Case
9 Chapter 9: Education, Research, and Performance Improvement
9.1 Adult Learning Principles & Staff Education 9.2 Quality Improvement Models & Implementation Science 9.3 Critical Appraisal of Infection Prevention Literature
4.3 PPE Selection, Donning, Doffing, & Safety
Key Takeaways Explain This Topic AI
The OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030) mandates employers provide appropriate PPE at no cost, enforce usage, and maintain an exposure control plan to protect against HBV, HCV, and HIV.
Respirator clearance under OSHA 1910.134 requires medical evaluation, annual qualitative or quantitative fit testing, and user seal checks prior to every entry into an airborne isolation environment.
CDC canonical Donning sequence (putting on): 1) Gown, 2) Mask or Respirator, 3) Goggles or Face Shield, 4) Gloves (over gown cuffs).
CDC canonical Doffing sequence (taking off - standard method): 1) Gloves, 2) Goggles/Face Shield, 3) Gown, 4) Mask/Respirator (doffed AFTER exiting room); alternative method removes gown and gloves simultaneously.
The outside front and sleeves of gowns, front of mask/goggles, and outside of gloves are considered contaminated; doffing must be performed slowly to prevent aerosolization and self-contamination.
Last updated: August 2026
4.3 PPE Selection, Donning, Doffing, & Safety
Quick Answer: Personal Protective Equipment (PPE) includes specialized clothing or equipment worn by healthcare personnel to protect against infectious hazards. Regulated by the Occupational Safety and Health Administration (OSHA) under the Bloodborne Pathogens (29 CFR 1910.1030) and Respiratory Protection (29 CFR 1910.134) standards, PPE must be selected based on anticipated exposure risk. Adherence to exact donning (putting on) and doffing (taking off) sequences is essential to prevent self-contamination.
While engineering controls (such as negative pressure rooms) and work practice controls (such as needle safety devices) form higher levels of hierarchy in hazard controls, PPE provides indispensable individual barrier protection. Infection Preventionists are responsible for training staff, auditing compliance, and ensuring appropriate PPE selection across clinical departments.
- Regulatory Framework: OSHA Mandates
- OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030)
The OSHA BBP Standard protects employees from occupational exposure to blood and other potentially infectious materials (OPIM). Key employer obligations include:
Written Exposure Control Plan: Annual review and updating of the facility's exposure control plan.
Provision of PPE: Employers must provide appropriate PPE (gloves, gowns, masks, eye protection) in suitable sizes at no cost to employees .
Cleaning & Maintenance: Employers must clean, launder, repair, or dispose of PPE at no cost.
Hepatitis B Vaccination: Free Hepatitis B vaccination must be offered to all employees with occupational exposure risk within 10 working days of initial assignment.
Post-Exposure Evaluation: Immediate, confidential medical evaluation and follow-up after an exposure incident.
OSHA Respiratory Protection Standard (29 CFR 1910.134)
When healthcare workers require respiratory protection (e.g., against M. tuberculosis , measles, SARS-CoV-2), OSHA mandates a comprehensive respiratory protection program featuring:
Medical Clearance: Medical evaluation by a physician or licensed healthcare professional before fit testing or respirator use to ensure the employee is physically able to wear a respirator.
Annual Fit Testing: Qualitative (pass/fail based on taste/smell threshold detection, e.g., saccharin or Bitrex) or quantitative (numerical measurement of face seal leakage using instruments like a PortaCount) fit testing performed initially and annually thereafter, or whenever face structure changes.
User Seal Check: Required every single time a user dons a tight-fitting filtering facepiece respirator (N95) before entering a contaminated environment (positive and negative pressure checks).
Overview of PPE Components
PPE Element Types & Options Indications Key Infection Control Considerations
Gloves Clean (nitrile, vinyl, latex) vs. Sterile Contact with blood, body fluids, mucous membranes, non-intact skin, or contaminated surfaces Hand hygiene must be performed before donning and immediately after doffing . Gloves do NOT replace hand hygiene. Change gloves between tasks on the same patient
Isolation Gowns Non-sterile fluid-resistant vs. Impervious surgical gowns (AAMI Levels 1–4) Anticipated splash/spray of blood/body fluids or direct skin/clothing contact with contaminated environment Must cover torso fully from neck to knees, arms to end of wrists, and wrap around back. Fasten in back at neck and waist
Eye & Face Protection Goggles, full face shields, safety glasses with side shields Procedures likely to generate splashes, sprays, or splatters of blood, body fluids, or secretions Personal prescription eyeglasses are NOT eye protection . Goggles provide sealed eye coverage; face shields cover full face length
Respirator / Mask Surgical mask vs. N95 respirator vs. PAPR Surgical mask for Droplet Precautions; N95 or PAPR for Airborne Precautions N95 requires fit testing; PAPR (loose-fitting hood) does not require fit testing , provides higher protection (APF 25 vs 10), and accommodates facial hair
N95 Filtering Facepiece Respirator vs. Powered Air-Purifying Respirator (PAPR)
N95 Respirator: Tight-fitting negative-pressure respirator that filters at least 95% of airborne particles down to 0.3 micrometers. Requires medical clearance, initial/annual fit testing, and user seal checks.
PAPR: Positive-pressure device equipped with a blower unit, HEPA filter, battery, and loose-fitting hood/helmet. Offers an Assigned Protection Factor (APF) of 25 (compared to APF 10 for N95). PAPRs are ideal for personnel with facial hair, facial deformities, or those who fail N95 fit testing.
Step-by-Step Donning Sequence (Putting On PPE)
Donning must occur outside the patient room or in an anteroom prior to entering the patient care area. DONNING SEQUENCE (CDC Guidelines)
- ┌─────────────────────────────────────────────────────────┐
- │ STEP 1: Perform Hand Hygiene │
- └───────────────────────────┬─────────────────────────────┘
- │
- ┌───────────────────────────▼─────────────────────────────┐
- │ STEP 2: Put on Gown │
- │ (Cover torso neck-to-knees, fasten in back) │
- └───────────────────────────┬─────────────────────────────┘
- │
- ┌───────────────────────────▼─────────────────────────────┐
- │ STEP 3: Put on Mask or Respirator │
- │ (Secure ties/straps, fit nosepiece, user seal check) │
- └───────────────────────────┬─────────────────────────────┘
- │
- ┌───────────────────────────▼─────────────────────────────┐
- │ STEP 4: Put on Goggles or Face Shield │
- │ (Adjust headband to fit comfortably) │
- └───────────────────────────┬─────────────────────────────┘
- │
- ┌───────────────────────────▼─────────────────────────────┐
- │ STEP 5: Put on Gloves │
- │ (Extend gloves over wrist cuffs of gown) │
- └─────────────────────────────────────────────────────────┘
- Step-by-Step Doffing Sequence (Taking Off PPE)
Doffing is the high-risk phase for self-contamination. Doffing must be performed slowly and deliberately . Except for the respirator/mask, all PPE should be removed at the doorway or in the anteroom.
Key Principle: Contaminated vs. Clean Areas
Contaminated Areas (Outside/Front): Outside front and sleeves of gown, front of face shield/goggles, outside of gloves, front of mask/respirator.
Clean Areas (Inside/Back/Straps): Inside of gloves, inside of gown, gown ties at back, ear loops/straps of mask/goggles.
Standard Doffing Sequence (CDC Preferred)
REMOVE GLOVES: Grasp outside edge of opposite glove near wrist. Peel away from hand, turning glove inside out. Hold removed glove in gloved hand. Slide fingers of ungloved hand under wrist of remaining glove and peel off, creating a "glove-in-glove" bundle. Discard in waste container.
REMOVE GOGGLES / FACE SHIELD: Remove from back by lifting headband or ear pieces. Touch only headband/ear pieces, not the contaminated front surface. Discard or place in designated container for reprocessing.
REMOVE GOWN: Unfasten gown ties at neck and waist (taking care not to touch front). Allow gown to fall away from shoulders. Touching inside of gown only, turn gown inside out, roll into a bundle, and discard.
PERFORM HAND HYGIENE: Decontaminate hands with ABHR or soap and water immediately after removing gown.
REMOVE MASK OR RESPIRATOR: Perform AFTER exiting the patient room and closing the door. Grasp bottom ties or elastics, then top ties/elastics, and pull away from face without touching the front. Discard in waste receptacle.
PERFORM HAND HYGIENE: Decontaminate hands again after mask removal.
Alternative Doffing Sequence (Combined Gown and Glove Removal)
Grasp gown front and peel away from body so ties break. Roll gown inside out while peeling off gloves simultaneously into a single bundle, followed by eye protection, hand hygiene, mask removal outside room, and hand hygiene.