PPE in Phlebotomy: Donning and Doffing Order for Certification Exams

PPE Basics for Phlebotomy

Personal protective equipment creates a barrier between you and infectious materials. In phlebotomy, you are working with blood and sometimes other body fluids on every shift. PPE is not optional, and it is not just about protecting yourself. Proper PPE use also prevents you from carrying pathogens from one patient to another.

The type of PPE you need depends on the procedure you are performing and the precautions in place for that patient. Get this wrong, and you either expose yourself unnecessarily or fail to protect yourself adequately.

Standard PPE for Routine Phlebotomy

For a routine venipuncture on a patient under standard precautions, you need gloves. That is the baseline.

Gloves protect your hands from direct contact with blood during the draw and when handling tubes. They do not protect against needlesticks, which is why safe needle practices matter independently of glove use.

Beyond gloves, assess each draw for splash risk. If you are drawing from a central line, accessing a port, or working with a patient who moves unpredictably, consider adding eye protection. Use judgment based on the actual situation.

Glove Selection

Nitrile gloves are the standard choice in most healthcare settings today. They provide good chemical resistance, puncture resistance, and fit, with no latex proteins.

Latex gloves were the historical standard but are now avoided in many facilities due to latex allergy risk. Latex allergy can range from contact dermatitis to anaphylaxis, both in healthcare workers and patients. If your facility still stocks latex gloves, ask about patient latex allergies before use.

Vinyl gloves offer less protection than nitrile and are generally not recommended for blood draws. They tear more easily and do not conform as well.

Glove sizing: Gloves that are too large allow movement inside the glove that reduces tactile sensitivity. Gloves that are too tight can tear during the draw. Wear the correct size.

Change gloves between patients. Wearing the same gloves from room to room is a contact transmission risk. This seems obvious, but it remains a common observation in audits.

When Additional PPE Is Required

Additional PPE is driven by the isolation precautions in place for the patient. Know these precaution levels before you enter the room.

Contact Precautions

Used for patients with infections spread by direct or indirect contact with the patient or their environment. Common examples: MRSA, VRE, C. diff, scabies, wound infections with resistant organisms.

Required PPE: Gloves and gown for any patient contact, including blood draws.

Droplet Precautions

Used for infections spread by large respiratory droplets that travel short distances (typically within 3 feet). Common examples: influenza, pertussis, meningococcal disease, rubella.

Required PPE: Surgical mask when within 3 feet of the patient. Gloves and gown as indicated by contact risk.

Airborne Precautions

Used for infections spread by small particles that remain suspended in the air and can travel longer distances. Common examples: tuberculosis, measles, varicella (chickenpox).

Required PPE: N95 respirator (fit-tested), gloves and gown. Draws should occur in a negative pressure room when possible.

Splash or Splatter Risk

Any procedure with a reasonable chance of blood or fluid splashing toward your face requires eye protection. A face shield is preferred over safety glasses for high-splash procedures because it protects the sides of the face as well. Safety glasses with side shields are acceptable for lower-risk situations.

Donning Order

Put on PPE in this sequence so that each item is protected by the next:

1. Gown — Put on first. Tie at the neck and waist. The gown protects your clothing and skin.
2. Mask or respirator — Surgical mask or N95 as required. Ensure proper fit. For an N95, perform a seal check.
3. Eye protection — Goggles or face shield. Position so coverage is complete.
4. Gloves — Put on last. Pull glove cuffs over the gown cuffs to eliminate a gap at the wrist.

The donning sequence positions items from cleanest (gown) to the last item added (gloves), with gloves going on clean after everything else is in place.

Doffing Order

Doffing is where most exposure incidents happen. The outside of PPE is contaminated. Doffing incorrectly moves contamination to your hands or face. Remove PPE in this sequence, from most contaminated to least contaminated:

1. Gloves — Remove first. The outside of gloves is the most contaminated surface. Use the glove-inside-out technique: pinch the outside of one glove at the wrist, peel it off, hold it balled in your gloved hand, then slip two fingers under the cuff of the second glove and peel it off inside-out, enclosing the first glove inside it. Discard.
2. Eye protection — Remove by grasping the temples or the back strap. Do not touch the front surface, which may be contaminated. Set aside for reprocessing or discard.
3. Gown — Unfasten the ties. Pull the gown forward away from your body, rolling the outside surfaces inward to contain contamination. Discard.
4. Mask or respirator — Remove last, touching only the ties or ear loops, never the front of the mask. For a surgical mask, remove by the ear loops. For an N95, remove by the lower strap first, then the upper strap. Discard.

Perform hand hygiene after removing gloves and again after removing all PPE. Two rounds of hand hygiene when fully gowned down.

Double Gloving

Double gloving (wearing two pairs of gloves simultaneously) is not standard practice for routine phlebotomy. It reduces tactile sensitivity and is not required under standard precautions.

Double gloving may be appropriate in certain situations: when a patient is highly combative and tube breakage or inadvertent contact is likely, or in some forensic collection scenarios. Follow facility policy.

Hand Hygiene After Glove Removal

Gloves do not provide 100% protection. Micro-perforations can occur during use. Perform hand hygiene (soap and water or alcohol-based hand rub) every time you remove gloves. This is not optional and is not redundant.

Alcohol-based hand rub is effective for most pathogens. Soap and water is required for C. diff (spores are not killed by alcohol) and for visibly soiled hands.

Practice Questions