Table 2

Recognised errors in donning and doffing based on literature review that need to be emphasised in training28–30 32–36

Donning errorsDoffing errors
Did not perform hand hygiene before entering the roomDid not use proper glove-in-glove technique for glove removal
Did not tie the gown at both the neck and waistDid not remove gloves first
Selected a procedure mask instead of the N95 disposable respiratorNot doffing gloves inside out
Did not place mask straps properlyContamination frequently occurred when the contaminated outside surface of gloves was touched with bare hands during removal.
Did not properly seal the mask to the faceThe outer gloves were not the first doffing item when untying the outer shoe cover strings first.
Did not conduct a seal checkGloves and/or masks were not placed in the trash hamper
Did not use eye protectionRemoved potentially contaminated eye protection from the room
Glove cuff did not cover gown cuff.Did not use the foot pedal, but instead touched the hamper lid with bare hand
Did not don equipment in the recommended sequenceDid not place all or part of the gown into the designated hamper
Gloves were not donned last as part of the donning sequenceDid not use proper mask removal technique
Unfamiliarity with PPE itemsTouching the outer surface of a gown when rolling it up to reduce its volume after discard
Confusion about the wearing order of multilayered PPE itemsDid not use wall-mounted hand sanitiser before exiting the room
Not tying backstrap of gownRemoved other potentially contaminated items from the room
Did not perform hand hygiene after exiting the room
Did not doff equipment in the recommended sequence, for example, doffing gloves first and touching other PPE with bare hands
Touched unprotected areas of the body, which could have resulted in self-contamination
Adjusted the mask in the room, breaking the seal and potentially resulting in self-contamination
Touched surfaces in the room that were unnecessary, which could have resulted in greater contamination of the gloved hands
Difficulty in locating the coverall zipper-slider and pulling it down with gloved hands
Contacting contaminated PPE with bare hands during doffing
Doffing the gown with flourish
Doffing the gown from the front
Not rolling up the gown before disposal
Walking between clean and dirty areas of doffing space
Not completing hand hygiene after each step