Personal Protective Equipment (PPE) for CNAs: Step-by-Step Guide and Exam Tips

Personal protective equipment, almost always called PPE, refers to the gear you put on to protect yourself and your patients from the spread of infectious material. In a clinical setting, PPE typically includes a gown, gloves, a mask, and eye protection. You use PPE when caring for a patient who may be infectious, when you might be exposed to blood or body fluids, or when a patient is highly vulnerable to infection and needs protection from you.

On the NNAAP skills exam, PPE is tested as a complete sequence. You are expected to put it on (called donning) in a specific order and take it off (called doffing) in a different specific order. The order is not arbitrary. It is based on which items are most likely to be contaminated and how to remove PPE without spreading that contamination to yourself or the environment.

Why This Skill Matters on the CNA Exam

The evaluator on your NNAAP skills exam is checking that you follow the correct donning and doffing sequence from memory. The reason the order is standardized is that doing it wrong in a real facility can expose you or a patient to dangerous pathogens. The most common exam failure point is putting gloves on before the gown, or removing the mask before the gloves during doffing.

PPE is also evaluated indirectly throughout the rest of your exam. If you are performing a skill that involves contact with body fluids and you do not reach for gloves first, the evaluator will note it. Strong PPE habits signal to your evaluator that your infection control foundation is sound.

Each piece of PPE serves a distinct function: the gown protects your clothing and skin, the mask filters air and protects your respiratory tract, eye protection guards against splashes, and gloves protect your hands during direct contact. Understanding why each item exists makes the donning and doffing order easier to remember.

What You Need

• Isolation gown (paper or cloth, single-use)
• Disposable gloves (nitrile or latex, proper size)
• Surgical mask or respirator (N95 if required by the facility)
• Goggles or a face shield
• A trash receptacle for contaminated disposables

Step-by-Step: Donning PPE (Putting It On)

The donning order goes from largest to smallest, and from least to most likely to contact pathogens directly. Always perform hand hygiene before you start.

1. Perform hand hygiene. Wash your hands thoroughly before touching any PPE equipment. Even clean-looking hands can carry pathogens that could contaminate the inside of your gloves or gown before you put them on.
2. Put on the gown. Slip your arms through the sleeves and tie the gown at the back of your neck first, then at your waist. The gown should cover your arms fully and wrap around your back. The gown goes on first because it is the outermost protective layer and must be in place before anything else.
3. Put on the mask. Hold the mask by its ear loops or ties and position it over your nose and mouth. If there is a bendable metal strip across the top edge, press it against the bridge of your nose and mold it to your face so there is no gap. A gap at the nose defeats the purpose of the mask entirely.
4. Put on eye protection. Place goggles over your eyes or snap a face shield into position over your forehead. Adjust for a secure fit. Eye protection is put on after the mask because it sits on top and should not be disturbed once the mask is in place.
5. Put on gloves last. Pull on your gloves and extend the cuffs up over the sleeves of the gown. This closes the gap at your wrist so no skin is left exposed between the gown and the glove. Gloves go on last because they will be in the most direct contact with contaminated surfaces, and adding them last keeps the inside of the gloves clean until you are fully suited up.

Step-by-Step: Doffing PPE (Taking It Off)

The doffing order is the reverse of donning in terms of contamination risk. The most contaminated items come off first. Hand hygiene is performed twice during the doffing process.

1. Remove gloves first. Gloves are the most contaminated item because they have touched the patient and the environment directly. Grasp the outside of one glove near the wrist and peel it back, turning it inside out as you pull. Hold the balled-up glove in your remaining gloved hand. Then slide one or two bare fingers under the cuff of the second glove and peel it off, folding it over the first glove. You end up with both gloves contained inside each other, contamination on the inside, ready for disposal.
2. Perform hand hygiene. Wash or use alcohol-based hand rub immediately after removing gloves. Even intact gloves can allow microscopic transfers. Do not skip this step and move directly to removing other PPE.
3. Remove eye protection. Grasp your goggles or face shield by the side arms or the back strap. Do not touch the front-facing surface, which may have splashes or aerosol contamination on it. Lift the goggles away from your face and place them in the designated container for reprocessing, or discard if single-use.
4. Remove the gown. Unfasten the ties at your neck and waist. Grip the inside of the gown at the shoulders and pull it away from you, rolling the outside of the gown inward as you go. The contaminated outer surface gets folded to the inside during removal, which is why you roll rather than pull straight off. Discard the gown in the waste container.
5. Remove the mask last. The mask is removed last because removing it earlier could expose your respiratory tract to airborne particles still in the environment. Grasp the mask only by the ear loops or the bottom tie strings. Pull it away from your face without touching the front of the mask. Discard it without letting the outer surface contact your face, eyes, or clothing.
6. Perform hand hygiene again. Wash your hands after completing the entire doffing sequence. This is the final safeguard against any contamination that may have transferred to your hands during removal.

What the Examiner Looks For

• Hand hygiene is performed before donning begins
• Donning order: gown, mask, eye protection, gloves (gloves always last)
• Gown is tied at both the neck and the waist
• Mask is molded to the nose so no gap exists at the bridge
• Glove cuffs extend over the gown sleeves
• Doffing order: gloves, hand hygiene, eye protection, gown, mask, hand hygiene
• Gloves are removed using the peel-and-ball technique, touching only the outside of the first glove
• Eye protection is removed without touching the front surface
• Gown is rolled inside out during removal
• Mask is removed by ear loops or ties only, not by touching the front
• Hand hygiene is performed a second time at the end of doffing

Common Mistakes to Avoid

• Putting gloves on before the gown. Gloves always go on last. The gown must be fully tied and in place so the glove cuffs can overlap the sleeves and close the wrist gap.
• Skipping hand hygiene during doffing. Many students remove all PPE in one continuous motion and wash hands only at the very end. The hand hygiene after glove removal is a separate, required step in the middle of the sequence.
• Touching the front of the mask when removing it. The front of the mask is the most contaminated surface. Reaching for the front is a habit from everyday mask use that you need to unlearn for exam purposes. Always reach for the loops or ties at the sides and back.
• Not molding the mask to the nose. If the mask has a metal nose strip and you do not press it down, there is a visible gap. The evaluator will notice. Take two seconds to pinch the strip before moving to the next step.
• Removing the gown by pulling it straight forward. Pulling straight forward drags the contaminated outer surface across your clothing and body. Roll it inward so the dirty side faces itself during removal.
• Forgetting the second hand hygiene at the end of doffing. Students who are relieved to have finished the PPE sequence sometimes walk away from the waste container without doing final hand hygiene. Build the habit of pausing for hand hygiene every time you discard PPE.

Printable Practice Checklist

Use this checklist when practicing with a partner or in front of a mirror. Check off each step as you complete it.

1. Performed hand hygiene before donning
2. Put on gown, tied at neck
3. Tied gown at waist
4. Put on mask, molded to nose bridge
5. Put on eye protection
6. Put on gloves last, cuffs over gown sleeves
7. Removed gloves first using peel-and-ball technique
8. Performed hand hygiene after glove removal
9. Removed eye protection by grasping from behind
10. Removed gown by rolling inside out
11. Removed mask by ear loops or ties only, not touching front
12. Performed final hand hygiene

PPE procedures are easier to master when you can practice with real gowns, gloves, and masks in a skills lab. Find CNA training programs near you to get that hands-on experience.

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