Protective Clothing: An Overview on Medical Gowns

Protective Clothing: An Overview on Medical Gowns

Purpose of medical isolation gown

Gowns are identified as the second-most-used piece of PPE, following gloves, in the healthcare setting. According to the Centers for Disease Control and Prevention’s Guideline for Isolation Precautions, isolation gowns should be worn to protect healthcare workers’ arms and exposed body areas during procedures and patient-care activities when anticipating contact with clothing, blood, bodily fluids, secretions and excretions. The isolation gown covers the torso and clothing and poses a physical barrier to the transfer of microorganisms and other materials.

Performance requirements of a medical gown

  1. Gowns must repel disease and infections from the wearer yet provide adequate freedom of movement.
  2. They must fit closely yet not restrict the movement
  3. Since there is excess fabric, gowns must withstand pulls during routine movements.
  4. These gowns must fit a diversity of body shapes and sizes.
  5. They must have easy donning and doffing without contamination, yet not have barrier might be breach.
  6. They should repel fluids but ventilate the wearer’s body heat.
  7. Since 2/3rd production cost for surgical gowns is in the fabric, effective fabric utilization is essential. And hence garment production costs must be carefully controlled.

Types of Medical Gowns

There are broadly two types of medical gowns: Disposable and reusable which are further classified into different levels depending on the level of protection required by the medical personnel in a certain situation. 

Gowns used in healthcare settings are defined and classified by Association of the Advancement of Medical Instrumentation (AAMI). It states that regardless of how the product is named (that is, isolation gown, procedure gown, or cover gown) when choosing gowns, one must look for product labelling that describes an intended use with the desired level of protection based on pre-established risk levels. Clearly, product names are not standardized and leads to confusion in the marketplace over the terminology of gowns.

Level-1: Minimal protection (Lowest liquid barrier protection)
To be used, during basic care, standard isolation, cover gown for visitors, or in a standard medical unit
PPE - medical gowns

Level-2: Low protection
To be used, for example, during blood draw, in the Intensive Care Unit (ICU), or a pathology lab. Two tests are conducted to test barrier protection performance:
  • Water impacting the surface of the gown material
  • Pressurizing the material
PPE - medical gowns

Level-3: Moderate Protection
To be used during arterial blood draw, inserting an intravenous (IV) line, in the Emergency Room, or for trauma cases. Two tests are conducted to test barrier protection performance:
  • Water impacting the surface of the gown material
  • Pressurizing the material
PPE - medical gowns

Level-4:Highest Protection (Highest liquid barrier protection)
  • Used in HIGH risk situations
  • Prevents all fluid penetration for up to 1 hour
  • May prevent VIRUS penetration for up to 1 hour
In addition to the other tests conducted under levels 1-3, barrier level performance is tested with a simulated blood containing a virus. If no virus is found at the end of the test, the gown passes.
medical gowns

Critical zones for gowns

The critical zones include those areas where direct contact with blood, body fluids and other potentially infectious materials is most likely to occur, although areas outside of the critical zones can inadvertently be splashed or sprayed as well. 
Critical zones of a gown

The entire front of a gown (areas A, B and C), including the seam and other components, is required to meet at least the minimum level (Level 1) of barrier performance. Since the back of a gown (area D) is expected to stay dry, there is no liquid barrier performance requirement for that area. The critical zone of the surgical gown is comprised of at least areas A and B.

Fabrics for gown

Category 1: Disposable/Single-Use
Disposable (single-use) isolation gowns typically constructed of nonwoven materials alone or in combination with materials that offer increased protection from liquid penetration, such as plastic films. They can be produced using a variety of nonwoven fiber-bonding technologies (thermal, chemical, or mechanical) to provide integrity and strength.

The basic raw materials typically used for disposable isolation gowns are various forms of synthetic fibers (e.g. polypropylene, polyester, polyethylene). Fabrics can be engineered to achieve desired properties by using particular fiber types, bonding processes, and fabric finishes (chemical or physical treatments)

Category 2: Reusable/Multi-use
Reusable (multi-use) gowns are laundered after each use. Reusable isolation gowns are typically made of 100% cotton, 100% polyester, or polyester/cotton blends. These fabrics are tightly woven plain weave fabrics that are chemically finished and may be pressed through rollers to enhance the liquid barrier properties. Reusable garments generally can be used for 50 or more washing and drying cycles.

Design variations of isolation gowns

Cuff variations ad back closing options available in the market are enlisted in the figure below. Additionally, full back coverage gowns are also very prevalent. 
Design variations of isolation gowns

References: 

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