A sterile gown and gloves combination is a barrier-protection strategy designed to uphold the principle of asepsis, which is the purposeful reduction of microorganisms to prevent their transfer to a susceptible site on a patient. This technique is routinely employed during invasive procedures, such as surgery or the insertion of indwelling devices, where the risk of infection is significantly elevated. The gown and gloves create a physical shield, preventing the migration of bacteria and other pathogens from the healthcare worker to the patient. Adhering to the specific sequence of gowning before gloving, particularly using the closed technique, is paramount to maintaining a protective sterile field.
Preparing the Sterile Field and Hand Hygiene
The process begins with meticulous surgical hand antisepsis, which aims to remove transient flora and reduce resident flora on the hands and forearms. This is performed because human skin harbors countless microorganisms that can multiply rapidly in the moist environment under a glove. The scrub typically uses an antimicrobial soap or an alcohol-based hand rub for a specified time, often between two to five minutes, extending from the fingertips to the elbows. After rinsing, the hands must be kept elevated above the elbows to prevent recontamination. The scrubbed person then uses a sterile towel from the pack to dry their hands and forearms completely, moving from fingertips to elbow.
Once the hands are prepared, the sterile supplies must be organized on a clean, dry surface to create a sterile field. A circulating assistant opens the packaged gown and glove set by carefully handling only the outer wrapper edges and dropping the inner sterile contents onto the surface. The package’s inner surface defines the sterile field; however, a one-inch border around the perimeter of the field is considered non-sterile. Only the scrubbed person or a non-scrubbed person touching only the outer non-sterile surfaces should handle the sterile gown and inner glove packaging.
Donning the Sterile Gown
The sterile gown is carefully lifted straight up from the sterile field, keeping it away from the body and unsterile surfaces. The gown is folded so the inner surface faces the wearer and the outer, sterile surface faces away. The wearer inserts both arms simultaneously into the armholes, holding the gown at the shoulders or neck opening to avoid touching the outside.
The hands must remain within the gown sleeves, stopping short of the cuff’s edge; this is the closed technique. A circulating assistant helps pull the gown over the shoulders and ties the inner neck and waist ties, taking care to touch only the inside of the gown and the ties. The wearer must keep their hands covered by the gown’s sleeves, manipulating them like “puppet hands,” as bare skin is considered surgically clean, not sterile.
The gown is considered sterile only in the front, from the mid-chest level to the waist, and on the sleeves from two inches above the elbow to the cuff. The back of the gown, the neck area, and the area below the waist are unsterile. Therefore, the wearer must avoid turning their back on the sterile field or leaning against unsterile objects. Keeping the hands covered protects the sterility of the gown’s cuff for the next step.
Performing the Closed Gloving Technique
The closed gloving technique is executed entirely through the gown sleeves using the fabric-covered hands to manipulate the gloves. The covered hands open the inner sterile glove package, which was dropped onto the sterile field. The first glove is picked up by the folded cuff, ensuring the fingers of the glove point toward the wearer’s elbow.
The glove is positioned palm-to-palm over the gown cuff, aligning the thumb of the glove with the thumb of the covered hand. The covered hand grasps the folded cuff edge of the glove through the gown sleeve. This is a crucial step, as the gown’s cuff acts as a sterile buffer between the hand and the glove’s sterile exterior.
The covered hand uses the gown material to stretch the glove opening and pull the glove completely over the gown cuff and the hand. The glove’s cuff is pulled up and over the gown sleeve, fully enclosing the gown cuff. This creates a continuous, sterile barrier from the forearm to the fingertips. The process is repeated for the second hand, using the now-gloved hand to position and pull the second glove over the remaining gown-covered hand. Final adjustments for a snug fit can be made by touching the outside of the gloves with the opposite gloved hand.
Post-Procedure Checks and Safe Doffing
Post-Donning Checks
After the gloves are successfully donned, the wearer must visually inspect both gloves for tears, holes, or defects that could compromise sterility. Verify that the glove cuff fully extends over the gown’s cuff, ensuring no fabric cuff is exposed, as this area can wick moisture. The sterile field is maintained by keeping gloved hands within the sterile zone of the body, which is above the waist and below the shoulders.
Safe Doffing Procedure
At the conclusion of the procedure, the removal of the gown and gloves, known as doffing, must be performed in a specific sequence to prevent self-contamination. The gown is removed first, as it is considered the most contaminated item, especially the outer front surface. The circulating assistant unties the neck and back ties, and the wearer grasps the gown at the shoulders, pulling it downward and off the arms.
As the gown is removed, it is turned inside out, folding the contaminated outer surface inward, and rolled into a bundle before being discarded. The gloves are removed last using a technique that ensures no contaminated exterior surface touches the wearer’s skin. Grasp the outside of one glove near the cuff with the opposite gloved hand and pull it off, turning it inside out.
Hold this first, inside-out glove in the palm of the remaining gloved hand. Slide the ungloved finger under the cuff of the second glove to remove it inside out over the first glove. This “glove-to-glove, skin-to-skin” method safely sequesters the contaminated surfaces, which are then discarded, followed by a final hand hygiene procedure.