Ebola PPE for Nurses: How to Put On and Take Off Protective Equipment Safely

In Ebola outbreaks, health workers are infected far more often by taking off contaminated PPE the wrong way than by a failure of the equipment itself. This guide covers the principles. Your facility’s exact sequence and equipment, set by WHO, NCDC, CDC or your ministry, always come first.

The typical Ebola PPE ensemble

• Two pairs of gloves (inner and outer, outer with long cuffs).
• Fluid-resistant or impermeable gown or coverall.
• Waterproof apron if there is vomiting, diarrhoea or bleeding.
• Face protection: full face shield or goggles, plus a fluid-resistant mask or respirator (N95 or equivalent for aerosol-generating procedures).
• Head cover and boots or boot covers.

Putting it on (donning): key principles

1. Remove jewellery and personal items, tie hair back, drink water and use the toilet first.
2. Do hand hygiene.
3. Put on items in the order your protocol sets, usually inner gloves, gown or coverall, boot covers, mask or respirator, head cover, face shield, apron, then outer gloves over the gown cuffs.
4. Check that no skin is exposed, then have your observer check you again and confirm you can move freely.

Taking it off (doffing): where most infections happen

1. Doff in the designated area, slowly, with a trained observer reading each step aloud.
2. Disinfect outer gloves before each step that involves touching PPE.
3. Remove the most contaminated items first (apron, outer gloves), rolling them inside out away from your body.
4. Remove the face shield and head cover from the back, without touching the front.
5. Remove the gown or coverall inside out, then boot covers. Disinfect inner gloves between steps.
6. Remove the mask or respirator last, touching only the straps.
7. Remove inner gloves and do thorough hand hygiene.

Common mistakes

• Rushing at the end of a long, hot shift.
• Touching your face, or adjusting goggles, inside the patient area.
• Doffing alone, without an observer.
• Reusing single-use items.
• Staying in full PPE for too long. Plan shorter rotations in hot climates.

Practise before you need it. Ask your infection prevention team for a supervised drill this week.

Related: Ebola signs, symptoms and nursing care

Based on WHO and CDC Ebola PPE guidance. Educational content: always follow your national and facility protocol.