Your healthcare facility’s regular infection control and prevention procedures will vary depending on the types of services you provide. Small family clinics rarely need the strongest forms of Personal Protective Equipment (PPE), while major hospitals likely require a full range of protective clothing on a daily basis.
However, even small facilities that rarely worry about infectious diseases need to be prepared for anything that comes through their doors. Having a full range of PPE on hand allows your staff to provide urgent care to individuals in crisis with no delay or increased risk to your team.
Understanding Isolation Gowns
Although the United States Food and Drug Administration (FDA) regulates various medical gowns, manufacturers’ terminology varies and can be confusing. The FDA defines surgical isolation gowns as gowns that are constructed similarly to regular surgical gowns, with critical zones that must provide a high level of water resistance and coverage even when under pressure.
However, the critical zones on surgical isolation gowns extend all over the front of each gown instead of just the main part of the torso and forearms like standard surgical gowns. This includes the seams, which must hold up to normal wear and tear without developing small holes or rips.
Isolation gowns without the “surgical” descriptor in front also have critical zones that cover a large portion of the body, but these critical zones offer varying protection levels. The Association for the Advancement of Medical Instrumentation (AAMI) defines 4 levels of protection, with Level 1 offering the least protection and Level 4 offering the most. Only Level 4 gowns are appropriate for surgical use because of their very high water resistance.
Basic AAMI Levels
Level 1 isolation gowns are intended for tasks where the user’s clothes need to be protected, but the user is unlikely to come into direct contact with patient bodily fluids. Laundry workers, hospital visitors, and other low-risk individuals can use these gowns. They provide some protection from fluids and pathogens but may not hold up under long-term wear or protect against heavy saturation.
Level 2 isolation gowns are appropriate for blood draws, ICU work, and similar work that involves very low exposure to bodily fluids and pathogens. They provide some resistance to fluids but are not appropriate for extended exposure.
Level 3 isolation gowns provide strong protection and are best for emergency rooms, arterial blood draws, IV insertion, and other scenarios where exposure to low quantities of fluids is likely. However, they still do not have the same level of protection as Level 4 surgical isolation gowns, which are specifically engineered to hold up under higher levels of pressure and abrasion.
The three lower levels of gowns are less expensive because they are easier to produce and use lighter material. Hospitals and clinics should train staff on specific scenarios for each type of isolation gown depending on the wards or duties they are assigned to.
Sterile vs. Non-Sterile
Like most PPE, isolation gowns are available in sterile and non-sterile versions. Most scenarios that require surgical isolation gowns also require a sterile environment, so most non-sterile options are for AAMI levels 1-3.
As a general rule, sterile isolation gowns are required for surgeries or other sensitive environments where a non-sterile surface could easily introduce infectious pathogens to a patient’s body. Non-sterile isolation gowns are better for situations where a medical professional may be exposed to the patient’s bodily fluids or pathogens, but the risk of causing infection in a patient is very low. When in doubt, a sterile gown is always the safest option.
Non-sterile gowns can be stored in larger dispensers without additional packaging. Sterile gowns are delivered by the manufacturer in individual plastic bags and must be kept in these bags until the practitioner is inside the patient care area. Both can be kept in a designated isolation station with other PPE.
How to Use an Isolation Gown
Medical professionals should always wash their hands before and after putting on a gown, whether or not it is sterile. If the gown is too small for easy movement or is too large and risks getting snagged on nearby objects, the user should remove it and choose a more appropriate size.
Gloves should not be worn while putting on the gown. Instead, wait until after the gown is fully secured to put on a fresh pair of gloves. Pull up the gloves over the cuffs for better protection from fluids and pathogens.
Change gowns between patients or as soon as the gown becomes soiled with body fluids. Remove the gown in a designated area or before leaving the patient care area. Turn the gown inside out as you pull it off and avoid touching the surfaces that were exposed to the patient.
Hospitals should provide a designated bin for used isolation gowns, with separate bins for disposable and reusable gowns if needed. Small clinics may empty isolation gown bins at the end of every day, but large hospitals might need to empty the bins more frequently.
Manufacturers whose gowns conform to AAMI standards must test their completed gowns thoroughly for proper barrier protection. This gives hospitals and medical professionals better peace of mind when donning a gown.
Although isolation gowns do not usually have a shelf life, it’s safer to throw out old stock and buy new ones if you suspect the elastic or plastics in a gown may be brittle or otherwise compromised because of old age. Reusable isolation gowns also require frequent inspection of ties, fasteners, cuffs, seams, and other critical parts that are more vulnerable to wear and tear.
If wearing an isolation gown for an extended period during surgery or while assisting the same patient, take the time to check the front of the body for damage periodically. Although isolation gowns are strong, they are not completely immune to snags and rips caused by patient bed frames or equipment. Even a small gap in the gown can result in contact with blood or other bodily fluids that could be infectious.
Managing Isolation Gown Stock
Keeping the largest stock of isolation gowns possible makes it easier to deal with supply chain interruptions and serious emergencies. During the COVID-19 pandemic, hospitals consistently saw their stock of PPE decreasing, with insufficient shipments available from manufacturers. Even hospitals with large PPE stocks ran out, especially if they were caught off-guard at the very beginning of the pandemic.
The situation in early 2020 highlighted the need for hospitals to be more prepared than ever. Although pandemics are rare, influenza outbreaks and even mass casualty events may cause a sudden spike in PPE usage.
Keeping a minimum of a 30-day supply on hand makes it easier to deal with sudden events and resulting supply chain interruptions. Large hospital systems with major trauma wards should consider keeping an even larger supply. When on-site storage is limited, consider contracting with a storage provider for more space for your backup emergency supply.
Also remember to stock an adequate range of sizes and types of PPE. Gowns that are too large or small can interfere with staff members’ mobility, which in turn affects their job performance. Since isolation gowns should not be altered by hemming or rolling up the sleeves, having the proper size is essential.
Coveralls are more difficult for medical personnel to change in and out of, but they are essential for very high-risk infectious disease protection. Plus, they can easily be used in place of other Level 4 gowns in the event of a shortage. Even if your facility rarely encounters infectious diseases, keep a supply on hand so you can be prepared to serve your community in a crisis.
Prioritizing in Emergencies
Many high-level isolation gowns are reusable, which helps reduce the strain on your supplies during a shortage. Although there is a limit to how many times they can be reused, high-quality reusable gowns usually last for dozens of washes.
However, thin disposable gowns cannot be washed and must be thrown out even if they are not soiled. Even isolation gowns that are authorized for heavy reuse should be thrown out if they have heavy contact with patient fluids or show any signs of tears or snags.
In times of potential shortages, the FDA also recommends saving surgical isolation gowns for staff who may come in contact with potentially infectious and highly resistant pathogens. For example, patients infected with COVID-19 were considered a priority for isolation gowns, especially if staff were coming into close, prolonged contact.
Your prioritization needs will vary depending on the services your facility provides. Having multiple contingency plans for temporary or ongoing shortages will improve your team’s reaction time in case of a crisis. Partnering with a supplier who knows how to source goods from new manufacturers and respond to continuously evolving situations can help minimize how much you have to cut gown usage.
Sourcing the Right PPE
Health care providers have a challenging job regularly, but when faced with a public health crisis, the stakes climb even higher. Your team and your community deserve the best protection possible, and having the right PPE is a critical part of this effort.
ICU Production is committed to serving hospitals and clinics with isolation gowns and other medical gowns for a wide variety of settings. We know the essential gear for your facility and the complexities of AAMI requirements. Our team has risen to the challenge of sourcing supplies during COVID-19 and is ready to tackle any scenario in the future.
Whether you’re a small family practice or a major hospital system, we’re happy to work with you to meet your needs. Contact us today at 1 (323) 970-2513, so we can start preparing the PPE you need.