Medical gowns, a form of personal protective equipment (PPE), function as a barrier in healthcare settings. This protective garment is designed primarily to shield the wearer’s skin and clothing from contamination by potentially infectious liquid or solid materials. By providing this physical separation, the gown helps prevent the transfer of microorganisms between the wearer and the patient, or between the patient and the healthcare environment. The specific circumstances dictating the use of a gown are determined by assessing the potential for exposure to contaminants.
The Principle of Anticipated Exposure
The fundamental decision-making process for gown usage centers on the principle of anticipated exposure, which means predicting the likelihood of contact with infectious substances. This risk assessment is the basis for all infection control guidelines. The gown must be worn anytime a procedure or patient care activity is expected to generate splashes, sprays, or substantial contact with body fluids, secretions, or excretions.
This principle is integrated into Standard Precautions, the minimum infection prevention practices applied during the care of all patients. Even if a patient has no known communicable disease, a gown is required if the task involves handling items visibly soiled with blood or other potentially infectious material. The anticipated volume of fluid, the duration of the activity, and the potential for penetration all influence the selection of the correct gown type. Gowns are selected based purely on the expected degree of contamination risk during the interaction.
The barrier performance of a gown is classified into four levels, ranging from Level 1 (minimal risk) to Level 4 (high risk). Selecting a Level 1 gown is appropriate for basic care where only minimal fluid exposure is expected. Higher-level gowns offer greater fluid resistance for more demanding tasks. This classification system ensures that the garment’s protective capacity matches the specific hazard presented by the patient care activity.
Gown Use in Standard Patient Care and Isolation
Gowns are routinely integrated into standard patient care for activities where contact with soiled materials is unavoidable. Simple tasks such as assisting a patient with bathing, providing extensive personal hygiene, or changing heavily soiled linens necessitate the use of a gown to protect the wearer’s uniform and skin. A gown is also needed when managing patient care devices that may involve contact with fluids, such as emptying a urinary catheter bag or cleaning up a biological spill.
The use of gowns becomes mandatory under specific Transmission-Based Precautions, particularly Contact Precautions, which are implemented for patients with infections easily transferred through physical contact. Pathogens like Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), or Clostridioides difficile (C. difficile) require this additional level of protection. In these scenarios, the gown must be donned immediately upon entering the patient’s room or care area.
The gown serves to contain infectious agents to the immediate patient environment, preventing the wearer from carrying them out of the room on their clothing. This containment strategy ensures that the outside surfaces of the gown bear the contamination. Consequently, the gown must be removed and discarded before the wearer exits the patient’s room to prevent the spread of the microbe to other patients or surfaces in the facility. Strict adherence to donning upon entry and doffing before exit is a defining characteristic of gown use in isolation settings.
Gowns for Invasive and High-Risk Procedures
In certain medical settings, the gown serves a dual protective role, safeguarding both the wearer and the patient from contamination. This requirement is paramount during invasive procedures where the patient’s internal tissues are exposed and a sterile field must be maintained. The key distinction in these high-risk scenarios is the use of sterile surgical gowns, which have undergone a validated sterilization process to eliminate all viable microorganisms.
Sterile surgical gowns are typically required for procedures such as major surgery, the insertion of central venous catheters, or extensive dressing changes involving large, open wounds or burns. These garments offer a high degree of fluid resistance and barrier integrity to withstand the potential for blood loss and irrigation fluid use. The specialized material and construction of these gowns prevent the passage of microorganisms from the wearer’s skin and clothing to the sterile field, thereby protecting the patient from surgical site infections.
Unlike non-sterile isolation gowns, which focus primarily on protecting the wearer, sterile gowns are packaged and handled to preserve their sterility until the moment of use. The critical zones of protection on a surgical gown, including the front of the body from the chest to the knees and the sleeves, must be impermeable to fluids. This robust barrier is essential for procedures where the duration is long and the anticipated exposure to bloodborne pathogens is substantial.
The Sequence of Donning and Doffing Gowns
The timing of gown use is procedural and follows a specific sequence for both donning and doffing the PPE to maximize protection. When donning, the gown is typically put on first, covering the torso, arms, and clothing, and fastened at the neck and waist. Gloves are always the last item to be donned, ensuring they are pulled over the cuffs of the gown to create a continuous barrier over the wrist and forearm.
The sequence for doffing is even more significant because it must prevent the contaminated outer surface of the gown from touching the wearer’s skin or clothing. Gowns and gloves are considered the most contaminated items and are often removed together or the gloves are removed first. The gown is unfastened and carefully pulled away from the neck and shoulders, then turned inside out, rolling the contaminated exterior into a bundle that is touched only on the clean inside surface.
This inside-out technique is performed immediately after the task is completed and before exiting the patient care area. Improper timing, such as removing the gown outside the room or failing to turn it inside out, can lead to self-contamination and the spread of pathogens. Following the removal of the gown, hand hygiene must be performed immediately using an alcohol-based hand rub or soap and water to complete the infection control process.