Medical gowns are a form of Personal Protective Equipment (PPE) worn by healthcare personnel to protect themselves and patients from the transfer of microorganisms and bodily fluids. They function as a physical barrier, minimizing the risk of contamination between the wearer’s clothing or skin and potentially infectious materials. Proper use is essential for infection control, ensuring pathogens do not spread within a healthcare environment. These garments cover the torso, arms, and upper legs, acting as a shield during procedures where exposure is anticipated.
Gown Selection and Pre-Procedure Hygiene
Meticulous hand hygiene, using soap and water or an alcohol-based hand sanitizer, is the first step before touching the gown. This action is foundational to the entire process, ensuring that hands do not introduce contamination to the clean inner surface. The selection of the appropriate gown type is based on the anticipated risk of exposure to fluids or infectious agents.
Isolation gowns are typically non-sterile and suited for general patient care with low to moderate contamination risk, such as routine examinations or simple wound dressing. These garments are classified by their barrier performance against liquid, often following the AAMI system, which ranges from Level 1 (minimal risk) to Level 4 (high fluid barrier protection). Conversely, surgical gowns are always sterile and reserved for invasive procedures where high fluid protection and sterility are required.
The gown must be the correct size, covering the torso from the neck to the knees and the arms from the wrist to the shoulder, while allowing for full movement. An ill-fitting gown compromises the intended barrier protection by exposing skin or tearing easily. Handle the garment carefully to prevent the clean inner surface from contacting any contaminated area before it is fully donned.
Step-by-Step Guide for Donning
Donning begins by orienting the gown to identify the neck opening and the inside surface, which will rest against the body. Hold the gown out in front, allowing it to unfold naturally without letting it drag on the floor. Carefully slide both arms simultaneously into the sleeves, treating the inside of the gown as the only clean surface that can be touched.
Keep hands within the cuffs, especially if gloves are to be worn immediately after, to avoid contaminating the exterior or wrists. Secure the closure mechanism at the neck, often ties or Velcro, fastening it snugly. This closure must be fastened to prevent the gown from slipping down or exposing the neck area, maintaining the protective barrier.
Once the neck is secured, the gown must be fully wrapped around the back to cover all clothing. Close the open back using the waist ties, which are wrapped around to the front or side and secured with a bow or knot. For many isolation gowns, the waist ties are designed to be secured in the back, ensuring the gown fully covers the wearer’s back and sides.
A specific “wrap-around” technique is sometimes employed, where one tie is passed to an assistant or connected to a perforated tab that is circled around the back and tied. The function of the waist ties is to keep the back of the gown closed, ensuring that the wearer’s clothing is not exposed. The entire front and sleeves of the gown are now considered the protective barrier, and the wearer must avoid touching any outside surface.
Safe Removal Procedures
Gown removal, or doffing, is a distinct sequence designed to prevent the transfer of contaminated material to the wearer’s skin or clothing. The front, sleeves, and sides are always considered contaminated, and the process must begin by only touching the inside of the garment. The first action is to untie the waist ties, carefully breaking the knot or bow without touching the contaminated exterior.
The wearer should then reach behind to release the neck closure, taking care to only touch the inside of the gown or the clean ties. Once the neck and waist are unsecured, the gown is peeled away from the shoulders by reaching under the collar, touching only the interior surface. This action allows the gown to turn inside out as it is removed, effectively sequestering the contaminated outer surface.
As the arms are pulled out of the sleeves, the gown should be simultaneously rolled down from the shoulders toward the hands, ensuring the contaminated side is contained within the roll. The goal is to create a tight bundle where the clean interior is on the outside, and the soiled exterior is completely enclosed. This bundled gown must be immediately discarded into the designated receptacle without touching the outside of the container.
After the gown has been successfully removed and disposed of, the hands are considered potentially contaminated from the doffing process. Therefore, the final step in the removal procedure is to perform hand hygiene immediately, either by washing hands or using an alcohol-based sanitizer. This action removes any residual microorganisms, completing the infection control protocol and protecting the wearer.