Which sequence correctly reflects the PPE donning order for HD handling?

• A. Gown, two pairs of chemo gloves, eye/face protection, mask or respirator, shoe covers and hair cover; perform hand hygiene before and after
• B. Gown, shoe covers, gloves, mask, eye protection; no hand hygiene
• C. Gloves first, then gown, then mask
• D. Respirator first, then gown

Answer: (A)

The key idea is to don PPE for hazardous drugs in an order that preserves each barrier and minimizes the chance of self-contamination, with hand hygiene performed before you start and after you finish.

Start with a gown to create a protective barrier for the body and clothing. Then apply two pairs of chemotherapy gloves so you have an extra layer of protection on the hands, which helps during procedures and allows safe removal of the outer gloves if needed. Next, put on eye or face protection to shield the eyes from splashes, followed by a mask or respirator to protect the airway. Finally, don shoe covers and a hair cover to prevent contamination of footwear and hair from coming into contact with HD-contaminated surfaces or downstream areas. Hand hygiene is performed both before donning and after removing the PPE to remove any residues and reduce cross-contamination.

This sequence aligns with the goal of maintaining barrier integrity throughout donning and ensuring proper decontamination afterward. Other options either omit hand hygiene, start with gloves (which can contaminate gloves or skin), or place the respirator before the gown, which can compromise the protective stack.