Standardized operating procedures for maximizing safety and contamination control in sterile environments. In controlled environments, the proper application and removal of Personal Protective Equipment (PPE) are critical to preventing the transmission of infectious agents and maintaining sterile integrity. The NFK (Necessary Facility Kit) Gowning and De-gowning Protocols provide a standardized sequence to ensure maximum protection for personnel and patients. Contamination most often occurs during the removal of PPE. Therefore, strict adherence to the de-gowning sequence is just as important, if not more so, than the gowning process. These protocols are designed to minimize the risk of self-contamination and cross-contamination. Treat all PPE as potentially contaminated once it has been worn in a designated zone. Never touch the face or adjust PPE during use without first performing hand hygiene. Before initiating the gowning sequence, the environment and the individual must be prepared. This phase ensures that the sterile field is not compromised by the initial state of the personnel. Remove all wrist jewelry, watches, and rings that could impede the fit of gloves or tear PPE. Ensure that street clothes are fully covered by facility scrubs or designated undergarments. Long hair must be tied back. Wash hands thoroughly with soap and warm water for at least 40-60 seconds. Pay attention to the spaces between fingers and under fingernails. Dry hands completely with a disposable paper towel. Apply an alcohol-based hand sanitizer (ABHR) covering all surfaces of the hands. Rub hands together until they are completely dry. This step reduces the bacterial load on the skin significantly before donning sterile gloves. The gowning process follows a specific order to ensure that the cleanest items are put on last, protecting them from contamination by clothing or prior steps. Grasp the gown at the neck edge, allowing it to unfold without touching the floor. Slide hands and arms into the sleeves. If the gown has a closure system, have an assistant secure the ties at the neck and waist. Ensure the gown covers the torso and fits snugly over the wrists. Place the mask over the nose and mouth. If using an N95 respirator, perform a fit check to ensure a seal. Tie the strings securely at the back of the head and neck. Mold the nosepiece to the shape of the nose to prevent gaps. Do not touch the front of the mask once adjusted. Put on goggles or a face shield. Position the eye protection to cover the front and sides of the eyes. Adjust the strap to fit securely without pinching. If using a face shield, ensure it does not interfere with the mask seal. Don the gloves last. Pull the gloves over the cuffs of the gown to cover the wrist area completely. Ensure there are no tears or gaps. Once gloved, the hands are considered contaminated and should not touch bare skin or the face. De-gowning requires high concentration. The outer surface of PPE is heavily contaminated. The sequence is designed to keep your hands clean as you remove each layer. Perform hand hygiene immediately after removing all PPE. If hands become contaminated during the doffing process, stop and sanitize immediately before continuing to the next step. Grasp the outside of one glove with the gloved opposite hand near the wrist. Peel the glove away from the hand, turning it inside out. Hold the removed glove in the gloved hand. Slide bare fingers under the remaining glove at the wrist without touching the outside surface. Peel the second glove off over the first glove. Discard immediately in the waste bin. Unfasten the gown ties, taking care not to touch the front of the gown. Reach up to the shoulders and carefully pull the gown down and away from the body. Turn the gown inside out as it is removed. Roll or fold the gown into a bundle while ensuring the outer contaminated surface remains inside. Dispose of it properly. Remove goggles or face shield by handling the straps or headband. Lift the equipment away from the face without touching the front surface. If the shield is reusable, place it in the designated receptacle for disinfection; if disposable, discard in the waste bin. Remove the mask by untying or unhooking the bottom strap first, followed by the top strap. Lean forward slightly to allow the mask to fall away from the face without touching the front. Do not touch the front of the mask. Discard immediately. Once all PPE has been removed and disposed of, the final and most critical step is hand hygiene. Even if hands appear clean, they may have been exposed to microscopic contaminants during the removal process.NFK Gowning & De-gowning Protocols
Introduction to NFK Protocols
Key Principle
Preparation & Hand Hygiene
Jewelry and Attire
Initial Hand Wash
Alcohol-Based Hand Rub
The Gowning Sequence (Donning)
Gown
Mask or Respirator
Eye Protection
Gloves
The De-gowning Sequence (Doffing)
Critical Safety Warning
Gloves
Gown
Eye Protection
Mask
Post-Procedure Hygiene
Immediate Actions
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