A summary discussion on product selection of gowns
The routine practice of PPE selection is based on a proper risk assessment. This involves choosing the appropriate uniforms, shoes, gloves, surgical masks, respirator masks, eye protection, face shields, gowns, hair caps and shoe covers. Depending on the practice setting, this entire line up may be your ‘norm’ or it may be a new PPE shopping experience if you were not using the complete PPE spectrum in the past. As the line up of PPE expands, decisions need to be made on specific products and their performance. This is simple when the products are regulated, and with any luck, that regulation includes registration with Health Canada (or FDA for USA) or at least inclusion in a medical class device listing.
Gowns have several alias names: surgical gowns, isolation gowns, surgical isolation gowns, non-surgical gowns, procedural gowns, operating room g
owns, single-use gowns, reusable gowns, etc. The Government of Canada defines the two gown types as the following:
Isolation gowns protect the clothing of health care providers. They also protect visitors and patients because they prevent the transfer of microorganisms and body fluids in patient isolation situations (1).
Surgical gowns are sterile textile gowns. Health care providers wear these gowns when they are working in a sterile environment (1).
“All medical gowns are classified as Class I medical devices. Class I devices present the lowest potential risk and are subject to the Medical Devices Regulations. Despite their classification as low risk, medical gowns serve an important function. Pathogens are unable to penetrate the material, which protects both the wearer and the patient.” (1)
How do you pick between an isolation gown and a surgical gown? Dental treatment is not offered in a sterile setting, therefore automatically eliminating sterile gowns. Now that being said, should an office wish to use sterile gowns, have at it as no one is putting the brakes on their use, however, be prepared to have a method for the sterilization of textiles. The office could potentially choose sterile gowns for the more invasive procedures, noted this is not a MUST in the standards.
Isolation gowns are the more typical choice for a dental office and they serve the purpose of a barrier to protect the health care professional (HCP) from splatter, spraying, droplets, droplet nuclei; the entire aerosol line up. The level of risk is highly tied to the type of services being offered. If the service is not generating aerosols (NAGP) a lower risk gown can be selected as there will not be any spray, splatter and aerosols. If the procedure involves aerosols (AGP) then a higher protection gown can be chosen as there is a potential for spray, splatter and aerosols. Nonsterile, disposable isolation gowns, which are used for routine patient care in healthcare settings, are appropriate for use (2).
What is the most important performance factor for a gown? Fluid resistance. Testing centres test gowns with various methods of fluid penetration: impact, hydrostatic, synthetic blood and viral. The following table form the CDC depicts the performance of gowns based on the ASTM and AATCC testing for potential fluid penetration. The more fluid resistance a gown demonstrates the more ideal its selection is for AGP. The following table from the CDC displays how each level is challenged, the result of the challenge and the expected barrier effectiveness. Note that the levels of 1-4 start with lower effectiveness to the fluid barrier and climb to a higher level of protection.
1. Government of Canada. Personal protective equipment against COVID-19. Medical gowns. 2020. https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-devices/covid19-personal-protective-equipment/gowns.html?wbdisable=true 2. Centre for Disease Control. Personal Protective Equipment: Questions and Answers. March 14, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html 3. Centre for Disease Control. Strategies for Optimizing the Supply of Isolation Gowns. 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html