How to choose good protective clothing:

According to the Centers for Disease Control and Prevention (CDC), health care workers have the potential for exposure to biological fluids that are capable of transmitting diseases caused by viruses such as hepatitis B, hepatitis C, human immunodeficiency virus, and Ebola and others. The design of protective clothing (e.g., isolation gowns, coveralls, and surgical gowns) shields health care workers and patients from harmful microorganisms transferred by blood and body fluids and should be worn when a threat of exposure exists.

There is a variety of protective products available, so here are factors and details to help guide your selections.

Gown types

Figure 1. Personal protective equipment gown types

Gown selection factors

There are three primary factors that influence personal protective equipment (PPE) gown selection:

1. Purpose

Isolation gowns are generally the preferred PPE clothing. Choose isolation gowns for instances you anticipate arm contamination. Gowns should fit comfortably over the body, cover the torso, and have long sleeves that fit snuggly around the wrists.

2. Materials

Gowns are made primarily from cotton or a spun synthetic material. Each of these materials are available in varying degrees of fluid resistance. If fluid penetration is a concern, then choose a fluid resistance gown.

3.Risk

Choose clean or sterile gowns, depending on the particular risk factors involved. Use clean gowns generally for isolation purposes, while sterile gowns are only necessary when performing invasive procedures, such as inserting a central line. In this case, a sterile gown would protect both the patient and the health care worker.

It is important to understand the critical, primary protection zones of a gown when making a selection for a particular patient care scenario. The illustrations below indicate critical areas of both surgical and nonsurgical gowns.

Figure 2. Critical primary protection zone for surgical gowns

and nonsurgical gowns

Standards and performance requirements

Consensus standards for testing gown performance

The rating for isolation and surgical gowns is based on their ability to act as a barrier to liquids or liquid-borne pathogens. The Food and Drug Administration (FDA) recognized standard for gown rating was created by two organizations: the American National Standards Institute (ANSI) and the Association for the Advancement of Medical Instrumentation (AAMI).

ANSI is a private nonprofit organization that oversees the development of voluntary consensus standards for products, services, processes, systems and personnel in the United States. AAMI is an organization for advancing the development, and safe and effective use of medical technology. The FDA recognized standard from ANSI/AAMI is PB70:2012 and is known as the liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities.

Table 1. Defining four protective material levels

Level 1

• Use for minimal-risk situations
• Provides a slight barrier to small amounts of fluid penetration
• Single test of water impacting the surface of the gown material is conducted to assess barrier protection performance

Applicability:Blood draw from a vein, suturing, intensive care unit, pathology lab

Level 2

• Use in low-risk situations
• Provides a barrier to larger amounts of fluid penetration through splatter and some fluid exposure through soaking
• Two tests are conducted to assess barrier protection performance:

* Water impacting the surface of the gown material

* Pressurizing the material

Applicability:Blood draw from a vein, suturing, intensive care unit, pathology lab

Level 3

• Use in moderate-risk situations
• Provides a barrier to larger amounts of fluid penetration through splatter and more fluid exposure through soaking than level 2
• Two tests are conducted to assess barrier protection performance:

* Water impacting the surface of the gown material

* Pressurizing the material

Applicability: Arterial blood draw, inserting an I.V., emergency room care, trauma care

Level 4

• Use 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.

Applicability:Pathogen resistance, infectious diseases (nonairborne), large amounts of fluid exposure over long periods.

The FDA requires that surgical gowns get additional testing for tear resistance, seam strength, lint generation, evaporative resistance and water vapor transmission. The standard recognized by the FDA for this testing (ASTM F2407) was created by ASTM International.

ASTM International (formerly known as The American Society for Testing and Materials) is an international standards organization that develops and publishes voluntary consensus technical standards for a wide range of materials, products, systems and services.