General principles for selection and use of PPE
When selecting and using PPE, remember:
- PPE should protect the mucous membranes from exposure to blood and body fluids and self-contamination.
- PPE should be adequate, but not excessive, so as not to restrict movement or vision, increase the risk of heat stress for HCWs who may be required to wear the PPE for prolonged periods, or make donning and doffing the PPE more complex.
- PPE chosen should provide maximum protection with minimal discomfort for the wearer.
- Select PPE that is appropriately sized and fits correctly. PPE should also be of suitable quality to provide the required level of protection for the tasks to be undertaken.
- While wearing PPE, do not touch face protection (face shield, goggles or mask) while in the patient’s room.
- All staff who treat patients with suspected or confirmed VHF should be confident in the use of PPE.
- Each step when putting on and taking off PPE should be undertaken slowly and methodically, in accordance with the agreed sequence of the facility.
- Staff should remove any personal items that may become contaminated before donning PPE, such as staff ID cards, wrist watches, jewellery and stethoscopes.
- All health care facilities must ensure that a site-specific step-by-step process for the donning and doffing of PPE is developed and documented. Not only should PPE be put on appropriately, but removal of used PPE is high risk and requires a structured and systematic procedure.
- Dedicated separate areas should be set aside for donning and doffing PPE. PPE should be put on in a clean area away from the patient’s room to protect the PPE from contamination. PPE should be taken off immediately adjacent to the patient’s room to prevent the risk of contamination to other areas.
- Do not touch used PPE or contaminated surfaces in the area where PPE is taken off with bare hands or skin.
- If footwear or personal clothing (for example, underwear and socks) becomes contaminated by a patient’s blood or other body fluids, safely remove these items and discard them with the used PPE.
- Have a plan for a location for a HCW to shower if splashed with body fluids. If clothing or scrubs are contaminated, items may be cut off with scissors. Provide new scrubs prior to showering.
Selection of PPE – risk assessment
When assessing risk for selection of PPE, remember:
- A tiered risk management approach based on the clinical condition of the patient is recommended when selecting PPE.1
- A risk assessment must be undertaken prior to selecting the PPE level to use, which also considers the patient’s ability to follow instructions (for example, children who may unexpectedly vomit).
- Selection of PPE is graded into two levels of PPE being:
- Level 1 (Dry) – for use with clinically stable suspected VHF patients with ‘dry’ or low-risk symptoms only, such as fever, aches and fatigue
- Level 2 (Wet) – for use with suspected VHF patients who are clinically unstable or have ‘wet’ symptoms, such as diarrhoea, vomiting or bleeding, and for confirmed VHF patients.
- When selecting which level of PPE to be used, consider the tasks to be undertaken, the environment in which the PPE is to be used and the person using the PPE.
- If health care facilities decide to add or modify PPE, they must consider the risks and benefits of any modification, and train HCWs on correct donning and doffing in the modified procedures.
- Consideration should also be given to how to safely remove PPE. This may include:
- ensuring the type or style of PPE selected is relatively simple to remove (for example, boot or shoe covers may be too difficult to remove safely)
- providing a chair for staff to sit on while removing PPE, particularly footwear
- ensuring there is enough space for staff to be able to remove PPE without contaminating many surfaces.
While this guideline provides the principles for PPE selection and donning/doffing PPE sequences, health care facilities must always apply these to their own circumstances.
Level 1 (Dry) PPE
Level 1 (Dry) PPE may be used when evaluating a patient with suspected VHF and the patient has low-risk symptoms, that is, fever, headache, fatigue or malaise only.
All PPE is to be single-use and disposable and should include:
- a fluid-resistant long-sleeved gown that extends to at least mid-calf or fluid-resistant coveralls without an integrated hood
- a full-face shield or goggles
- a fluid-resistant P2/N95 respirator
- two pairs of gloves – the outer gloves should have extended cuffs (for example, sterile gloves can be used, as these have extended cuffs).
Note: head and neck coverings, and foot and leg coverings are not required.
Donning and doffing level 1 (Dry) PPE
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The buddy should help step the HCW through the agreed sequence for putting on PPE:
- Remove all personal items, such as jewellery, wrist watches and staff ID. Ensure hair is tied or pinned back, and prescription glasses are secured.
- Visually inspect PPE to check for integrity.
- Perform hand hygiene.
- Put on the first pair of gloves.
- Put on a long-sleeved gown and secure at the neck and waist.
- Put on P2/N95 respirator (follow the manufacturer's instructions to perform a fit check).
- Put on full-face shield or goggles.
- Put on second pair of gloves, ensuring the extended cuffs are pulled over the cuffs of the long-sleeved gown.
- Visually inspect that all PPE is on correctly and covers all mucous membranes.
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This is one recommended sequence for doffing Level 1 (Dry) PPE. Other sequences may be used by a health care service (for example, removing the gown and outer gloves in one motion). If a different sequence is used, staff must be adequately trained and be confident with the doffing sequence.
The buddy should open the lid of the clinical waste bin for the HCW prior to them taking their PPE off, and help step them through the agreed sequence for removal:
- Visually inspect PPE before leaving the room to check integrity of all items.
- Leave the room and move to the designated PPE doffing area.
- The buddy is to check for contamination.
- Remove outer gloves – peel glove from cuff down over fingers, so that the glove is inside out, and discard the glove into the clinical waste bin.
- Remove the long-sleeved gown – undo the waist ties before the neck ties, and roll gown into a ball and discard into the bin.
- Perform hand hygiene by applying ABHR to the gloves.
- Remove the face shield and discard into the bin.
- Perform hand hygiene by applying ABHR to the gloves.
- Remove the P2/N95 respirator and discard into the bin.
- Remove inner gloves – peel glove from cuff down over fingers, so that the glove is inside out, and discard into the bin.
- Perform hand hygiene.
- Visually inspect scrubs and:
- if contaminated, remove and discard into the clinical waste bin
- if not contaminated, discard them as non-infectious used linen, after taking them off in an uncontaminated zone.
If prescription glasses are worn:
- Put on a new pair of gloves.
- Remove and clean the glasses with a hospital-grade disinfectant wipe and allow to dry.
- Remove gloves and perform hand hygiene.
Level 2 (Wet) PPE
Level 2 (Wet) PPE is recommended for use when providing care for patients confirmed to have VHF or patients with suspected VHF who have high-risk secretory symptoms, that is, vomiting, diarrhoea or bleeding.
In addition to protecting the mucous membranes, PPE should also provide full protection of all clothing, skin and hair.
All exposed skin must be covered.
All PPE is to be single-use and disposable, and should include:
- surgical scrubs (or equivalent)
- a fluid-resistant long-sleeved gown that extends to at least mid-calf or fluid-resistant coveralls without an integrated hood
- a full-face shield or goggles
- a head cover that covers all hair, ears and neck, and extends to the shoulders
- a fluid-resistant P2/N95 respirator (see section 5.4.5 regarding use of powered air-purifying respirators (PAPRs))
- two pairs of gloves – the outer gloves should have extended cuffs (for example, sterile gloves can be used, as these have extended cuffs)
- enclosed, fluid and sharps-resistant footwear
- plastic apron if fluid contamination is anticipated.
Donning and doffing level 2 (Wet) PPE
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The buddy should help step the HCW through the agreed sequence for putting on PPE:
- Remove all personal items, such as jewellery, wrist watches and staff ID. Ensure hair is tied or pinned back, and prescription glasses are secured.
- Change into scrubs.
- Visually inspect PPE to check for integrity.
- Perform hand hygiene.
- Put on the first pair of gloves.
- Put on the head cover.
- Put on a long-sleeved gown, secure at the neck and waist.
- Put on a P2/N95 respirator (follow the manufacturer's instructions to perform a fit check).
- Put on a plastic apron.
- Put on a full disposable face shield.
- Put on a second pair of gloves, ensuring the extended cuffs are pulled over the cuffs of the long-sleeved gown.
- Visually inspect that all PPE is on correctly and all bare skin is covered and protected.
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This is one recommended sequence for doffing Level 2 (Wet) PPE. Other sequences may be used by a health care service (for example, removing the gown and outer gloves in one motion). If a different sequence is used, staff must be adequately trained and be confident with the doffing sequence.
- Before leaving the patient’s room, visually inspect PPE to check the integrity of all items. Wipe away any visible contamination using a hospital-grade disinfectant wipe.
- Leave the room and move to the designated PPE doffing area.
- Remove outer gloves – peel glove from the cuff down over fingers, so that the glove is inside out, and discard gloves into the clinical waste bin. Check if the inner glove is soiled. If so, use a disinfectant wipe to remove.
- Perform hand hygiene by applying ABHR to the glove.
- Remove the apron and discard into the bin.
- Perform hand hygiene by applying ABHR to the gloves.
- Remove the long-sleeved gown – buddy to undo the waist ties before the neck ties. Roll gown into a ball and discard into the bin.
- Perform hand hygiene by applying ABHR to the gloves.
- Remove the face shield and discard into the bin.
- Perform hand hygiene by applying ABHR to the gloves.
- Remove the head cover and discard into the bin.
- Perform hand hygiene by applying ABHR to the gloves.
- Remove the P2/N95 respirator and discard into the bin.
- Remove the inner gloves – peel the glove from the cuff down over fingers, so that the glove is inside out, and discard gloves into the clinical waste bin.
- Perform hand hygiene.
- Visually inspect scrubs and:
- if contaminated, remove and discard into the clinical waste bin.
- if not contaminated, discard them as non-infectious used linen, after taking them off in an uncontaminated zone.
If prescription glasses are worn:
- Put on a new pair of gloves.
- Remove and clean the glasses with a hospital-grade disinfectant wipe and allow to dry.
- Remove gloves and perform hand hygiene.
PAPRs
Use of PAPRs may be considered for Level 2 (Wet) PPE, particularly when staff will be with a clinically unstable patient for prolonged periods.
Facilities must develop their own procedures for the use of PAPRs, which will include donning/doffing procedures that align with the model of PAPR being used.
Other considerations if PAPRs are to be used include ensuring:
- all staff required to use this equipment have been trained and undertake refresher training on a regular basis
- adequate supplies of consumables
- equipment is maintained and serviced regularly as required
- waste generated can be adequately disposed of (for example, if clinical waste bins are sufficiently large for the hoods).
Buddy HCW role
The buddy should wear Level 1 (Dry) PPE, including a long-sleeved gown, face shield or googles, P2/N95 respirator and gloves.
Their role is to assist with the following actions:
- Help step the HCW through the agreed sequence for donning PPE. They can assist with donning PPE where required and should make sure all PPE is comfortable and correctly fitted before the HCW enters the patient room.
- Observe and advise the HCW while in the patient room for actual/potential PPE breaches (the buddy does not enter the room).
- Monitor and guide the HCW in designated removal area to ensure PPE is removed slowly and in the correct order, to avoid contamination of the HCW and the surrounding environment. The buddy’s role is to:
- visually inspect HCW PPE to check for integrity and contamination. If visible contamination is observed, pass the HCW a disinfectant wipe to remove any soiling
- read out steps for doffing PPE (consider using a checklist)
- ensure correct hand hygiene technique is used when taking off PPE and dispense alcohol-based hand rub to prevent contamination of the dispenser
- untie gown waist and neck ties
- ensure all PPE is appropriately disposed of into the clinical waste receptacle
- wipe chair, sink and floor with disinfectant in the doffing area.
- Accept waste from the patient room into another clinical waste bag. The buddy should hold the new clinical waste bag so the bag overlaps their hands, and the inner waste bag can be placed into the bag without coming into contact with the hands of buddy.
- Identify (and record if appropriate) any PPE breaches during patient care or during PPE removal. If a breach is seen during care, advise staff to leave the patient room, and if body fluids are seen on PPE, pass them a disinfectant wipe prior to removal of PPE. Seek advice from infection control or infectious diseases if the HCW is exposed.
Training
Specific and repeated training for HCWs is desirable, and all staff who treat patients with suspected or confirmed VHF should be confident in the use of PPE.
Training should also take place in the room and/or area a patient with VHF may be managed to ensure staff are familiar with the location.
Training sessions may highlight problems with types of PPE used and the sequences for donning and doffing PPE. Use these sessions as an opportunity to make improvements or adaptations as required.
Training should include:
- how to don and doff PPE, including the correct order to avoid cross-contamination
- how to check correct fit of PPE, including P2/N95 respirators
- disposal of used PPE and decontamination
- maintenance and storage of PPE
- hand hygiene.
Notes
1 Commonwealth of Australia. (2015). Infection prevention and control principles and recommendations for Ebola virus disease: Including information about personal protective equipment for clinical care of patients with suspected or confirmed Ebola virus disease in the Australian healthcare .
Reviewed 26 February 2026