Buyer's Guide on Selecting the Best Isolation Gowns

Isolation gowns serve a critical function in infection control by protecting healthcare employees, workers, and individuals from transferring bacteria and body liquids in clinical settings. In recent years, significant attempts have been made to develop new materials and manufacturing techniques to meet consumers' design needs and improve barrier protection.

Considering several factors such as barrier effectiveness, risk exposure level, comfort, donning and doffing time, etc., can help make the best buying decision while selecting the ideal gown for you.

Barrier Effectiveness

Isolation gowns are available in varying degrees of barrier resistance to blood or other body fluids in the market. They are generally classified as disposable or reusable. However, disposable gowns are utilized more in U.S. healthcare than in Europe.

The barrier effectiveness of the isolation gowns is determined by their building materials. Disposable isolation gowns are typically composed of nonwoven fabrics made of a broad range of synthetic fibers or in combination with other materials like plastic films. Currently, ANSI/AAMI PB70 standard is used to classify gowns as per their liquid barrier performance.

The AAMI PB70 standard incorporates four standard tests to examine isolation gowns barrier effectiveness. Based on these standardized tests outcomes, four levels of barrier performance are established (Level 1 as lowest level of protection and Level 4, the highest).

Exposure to Risk

Some of the factors crucial to evaluating the exposure to risk in healthcare facilities involve modes of transmission, source, pressures and types of contact, time span and tasks. Identifying the expected fluid amount and exposure has great significance when selecting the appropriate gown.

According to the standard, level 1 to 3 gowns could be used in minimum to moderate fluid exposures such as simple nose, ear, biopsies, and throat procedures, as well as arthroscopic, orthopedic, mastectomies, and gastrointestinal procedures.

Even though selecting a suitable gown depends on expected fluid exposure, it may be based on the availability of a gown at a certain level of protection within the healthcare institution. During emergencies or times of pandemics, PPE shortages are likely to occur. So, when gowns with higher levels of protection are unavailable, healthcare workers may resort to wearing gowns with lower protection levels.

Standards and Performance Requirements

The ANSI/AAMI standard comprises four tests to assess the barrier effectiveness of drapes and protective gowns (surgical and isolation). These test methods are as follows:

Impact Penetration Test: This measures the fabric's resistance to insertion of water by spray impact, as estimated by weight gain of a blotter. A lower number represents higher resistance.

Hydrostatic Pressure Test: This measures the fabric's resistance to water penetration under continually increasing hydrostatic pressure, calculated as hydrostatic resistance. A higher number denotes higher resistance.

Synthetic blood penetration resistance: This is used to assess the material resistance to artificial blood penetration under conditions of constant liquid contact and only pertains to surgical drapes.

Bloodborne pathogens penetration resistance: This measures the resistance of materials employed in protective clothing to invasion by bloodborne pathogens, using a surrogate microbe under conditions of constant liquid contact.

ANSI/AAMI PB70 classifies specific areas of isolation gowns as critical zones. The critical zones encompass those areas where direct contact with blood, body fluids, and other potentially infectious materials is most likely to occur.

According to the standard, the whole garment is considered a critical zone for isolation gowns, including seams and excluding cuffs, hems, and bindings. AAMI TIR 11 provides considerations for selecting the PPE based on the predicted exposure to potentially infectious fluids.

Time to Don and Doff

There are usually three types of isolation gowns neck closures, including tape tab, tie, and hook and loop neck closures. Some gowns featuring hook and loop neck closures are intended for easy adjustability, while the tape tab neck closures are for comfort and to reduce donning and doffing time. Gowns featuring a hook and loop style neck closure also allow the neckline to conform to various sizes quickly.

According to a survey conducted among HCWs, neck closures and donning problems are recognized as some of the most common issues with isolation gowns. Select the isolation gown that allows easy donning and doffing, as the time required for putting on and removing can be critical, especially for emergency room personnel or EMS workers.

Sizing/Fitting

Sizing is also one of the components that are critical for the protection and comfort of healthcare workers who wear isolation gowns. Different size options (small, medium, etc.) are offered in the market, in addition to universal sizing. It has been observed that the universal size sometimes does not fit the workers properly.

The gowns must support adequate freedom for HCWs to move around and be designed to fit multiple body shapes and sizes. They should be easy to put on and remove without contaminating the worker or the workplace.

Poorly fitted garments may prompt blood or OPIM to reach the skin or other clothing easily. CDC advises to have different sizes of gowns available in a medical facility to assure appropriate coverage for healthcare members.

Disposable Vs Reusable

Hospital isolation gowns are composed of either reusable or disposable materials. Both have their pros and cons when it comes to maintenance, protection, comfort, cost, and environmental impact. Each of these categories features considerable variation regarding design and performance characteristics.

Several studies have been done to compare different materials (reusable, disposable) and with different wearers, resulting in mixed results. However, a consistent conclusion is that impermeable materials efficiently reduce the transfer of microorganisms but at the cost of the thermal comfort of the wearer.

Fabric Properties

Chemically speaking, the absorbency of the fiber is crucial for the liquid transmission features of the gowns. When highly absorbent fibers are present, the fabric absorbs the liquid, trapping the bacteria within the fiber structure.

If hygroscopic or low absorbent fibers are utilized for the gown construction, the liquid wick along the fiber surface, intensifying the capillary movement of liquid that carries microorganisms. Natural fibers, such as cotton, wool, silk, etc., have greater absorbency capabilities compared to synthetic fibers like polypropylene and polyester, commonly used in isolation gowns manufacturing.

Several studies have discovered that the fabric properties, such as wicking, pore size, repellency, and fabric thickness, impact the barrier effectiveness. Fabrics with smaller pore sizes have better barrier effectiveness to bacterial transmission.

Bottom Line

With so many brands out there, buying the perfect isolation gown wouldn't be such a daunting task if you equip yourself with an understanding of where you will be using the gown, how much risk is involved, various standards to keep in check and the design that will offer the best comfort without compromising your safety.