The surgical gown serves as a physical separation between the non-sterile environment and the sterile surgical field. Its primary function is to maintain asepsis, preventing the transfer of microorganisms from the surgical team to the patient’s open surgical site. The procedure for putting on this gown, known as donning, is a highly standardized protocol designed to establish a barrier that minimizes the risk of surgical site infections. Adhering to precise steps ensures the gown functions effectively as a protective layer for both the patient and the healthcare provider.
Pre-Gowning Preparation
Before touching the gown package, the surgical hand scrub must be performed meticulously. This systematic chemical and mechanical cleansing extends two inches above the elbow, aiming to reduce microbial flora to the lowest possible number. A typical scrub uses an antimicrobial agent, such as povidone-iodine or chlorhexidine gluconate, lasting two to five minutes depending on facility protocol.
The mechanical action involves scrubbing all four surfaces of the fingers, hands, and arms. Throughout the scrubbing and rinsing process, the hands must be held above the elbows. This elevated position allows water to run from the cleaner area (hands) toward the less clean area (elbows), maintaining the highest level of antisepsis on the hands. After rinsing, the individual must carefully walk into the operating room while maintaining this hand position.
Upon entering the room, the hands are dried using a sterile towel provided within the gown pack. The towel is opened without letting it touch any non-sterile surface. One end is used to thoroughly dry one hand and forearm with a blotting motion. The towel is then discarded, and the opposite end is used for the other hand and forearm.
The Sterile Donning Procedure
The sterile gown is typically packaged inside the sterile wrap of the surgical tray. The scrubbed individual approaches the sterile field to retrieve it. The scrubbed person lifts the gown directly upward by grasping the inside of the neckband or collar. This ensures that only the non-sterile interior of the gown is initially touched, preserving the sterility of the exterior surfaces.
Once the gown is lifted, the individual must step away from the sterile table to give themselves adequate space for unfolding. The gown is allowed to fall open by gravity, taking care that the outer surface does not brush against any non-sterile item or the floor. The inside of the gown faces the wearer, and the exterior, which forms the sterile barrier, faces away.
The arms are then slid into the sleeves simultaneously, keeping the hands at shoulder level. The goal is to insert the arms fully into the sleeves without letting the hands protrude through the cuffs. This maneuver prepares for the closed gloving technique.
The hands must remain fully enclosed within the sleeve cuffs, with the fabric completely concealing the fingers and thumb. This technique prevents the non-sterile skin of the hand from contacting the sterile exterior of the glove or the gown. The wearer is now sterile from the chest to the level of the sterile field, but the back is not yet secured. The hands remain hidden within the fabric, awaiting the assistance of a non-sterile team member.
Securing and Completing the Barrier
With the wearer’s arms in the sleeves, a non-sterile circulating nurse or assistant approaches the back of the gown. This assistant only touches the inside back of the gown, which is considered non-sterile, and secures the ties at the neck and the inner waist. This secures the gown to the wearer’s body, preventing it from slipping off. This action does not yet complete the sterile field over the front of the wearer.
The complete sterile field is established by securing the outer waist tie, which is attached to a removable transfer card. The wearer first separates this outer waist tie from the gown’s front without touching the end of the tie itself. The sterile person then extends the tie, keeping the card attached, away from their body and toward the sterile field.
The sterile surgical team member hands the entire transfer card, still attached to the tie end, to another team member who is already scrubbed and gowned. The wearer then performs a controlled 360-degree turn, or “spin,” while the sterile colleague holds the end of the tie and card away from the wearer’s body. This maneuver ensures the entire back of the gown is covered by the tie as the wearer turns.
Once the turn is complete, the wearer retrieves the tie end from the sterile colleague, who releases the card. The two free ends of the waist tie are then secured together in the front. This front tie is the final component that seals the sterile barrier around the wearer’s midsection, allowing the front surface to be considered sterile.
The gowning process is structurally complete, but the barrier remains compromised until the hands are covered. The immediate next action required to finalize the sterile field is the application of sterile surgical gloves using the closed gloving technique.