A nurse is caring for a patient with suspected Ebola virus disease in the isolation unit. Which sequence of personal protective equipment (PPE) removal is most critical to prevent self-contamination?

The removal of personal protective equipment is a critical moment for healthcare worker contamination. The sequence must follow the principle of removing the most contaminated items first while preserving protection for the airway and mucous membranes until the end.

1. Gloves: Removed first as they are the most heavily soiled. This prevents the transfer of pathogens to the face or environment when handling other equipment.
2. Gown: Removed second by rolling it inside out, away from the body, without touching the outer surface. Clean hands from the previous step reduce recontamination risk.
3. Eye Protection: Removed third by handling only the earpieces or headband. The front of the goggles or face shield is considered contaminated.
4. Respirator Mask: Removed last to protect the respiratory tract until the very end of the process. It is handled by the straps only.

Perform hand hygiene immediately after removing all PPE. A trained observer should monitor and guide the entire doffing process to prevent protocol breaches.