Proper Donning and Doffing of Isolation Gowns: A Clinic Guide
A nurse in a Toronto long-term care home finished her morning rounds wearing the same isolation gown she had put on at shift start. She had entered and left three isolation rooms, removed the gown twice, and put it back on both times. When an infection control lead reviewed the workflow, she found the gown was being reused across rooms because staff did not know the correct removal sequence. The gown, which should have been removed inside the room and discarded, was instead carried into the hallway — a textbook route of cross-contamination. Proper donning and doffing is not a training nicety. It is the difference between a gown that protects and a gown that spreads.
Why Sequence Matters in Gown Removal
Isolation gowns are single-use barriers. During patient care, the outside of the gown is considered contaminated — it has touched the patient, the bed, the environment. The entire goal of doffing is to remove that contaminated surface without touching it with bare skin or clean clothing. The sequence exists to make the contaminated side fold inward as the gown comes off, so the wearer never contacts the soiled exterior.
Infection prevention and control (IPC) guidance in Canada, including material from the Public Health Agency of Canada, emphasizes that PPE removal must follow a deliberate order: gloves first, then gown, then mask and eye protection. Gloves are the most contaminated item, and removing them first prevents transferring contamination to the gown during removal. The gown comes off second, with the wearer breaking the neck and waist ties from behind and peeling the gown away from the body, turning it inside out.
The Doffing Sequence, Step by Step
Gloves: grasp the outside of one glove at the wrist and peel it off, holding the removed glove in the gloved hand. Slide two fingers of the bare hand under the remaining glove at the wrist, peel it off over the first glove, and discard both. Gown: untie or break the waist ties, then the neck ties. Reach behind and pull the gown forward over the shoulders, keeping hands inside the gown. Peel the gown down and away from the body, turning it inside out, and discard it immediately. Mask and eye protection: remove the mask by the ear loops or ties without touching the front, then dispose of it. Perform hand hygiene after every removal step.
That sequence is only as good as the gown's design. A gown with weak seams can tear during removal, exposing skin. A gown with poor tie placement makes the doffing motion awkward. Facilities that buy gowns on price alone often discover these problems in practice — during an actual donning and doffing drill, not in the brochure.
Choosing Gowns That Support the Protocol
When selecting isolation gowns, look for features that make correct use more likely: clearly positioned ties, adequate length and sleeve coverage, and a fluid-resistant barrier appropriate for the task. In Canada, gowns used in healthcare are commonly evaluated against the AAMI PB70 standard, which classifies protective apparel by liquid barrier performance from Level 1 to Level 4. A Level 1 gown suits minimal fluid exposure; a Level 2 gown is appropriate when moderate fluid contact is expected, such as in many LTC and clinical tasks.
CliniEco Medical offers both a Level 2 SMS isolation gown in 50-packs for tasks with moderate fluid exposure and a Level 1 non-woven gown for lower-risk contact. Stocking both levels lets staff match the gown to the task instead of defaulting to one option.
Training the Sequence Until It Is Routine
Posters in the gowning area help, but supervised practice is what builds muscle memory. Run a brief donning and doffing drill at orientation and again quarterly. Have staff demonstrate the sequence with a gown and gloves, and correct errors in real time.
Pair the gown training with the rest of the PPE kit. Staff should practice with nitrile examination gloves and ASTM Level 3 face masks so the full removal sequence — gloves, gown, mask — is practiced the way it will be performed.
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Frequently Asked Questions
What is the correct order to remove PPE?
Gloves first, then the gown, then mask and eye protection. Hand hygiene is performed after each removal step. The gown is peeled away turning inside out so the contaminated exterior never touches clean skin or clothing.
Can an isolation gown be reused between patients?
No. Isolation gowns are single-use barriers. Reusing a gown across patients or rooms defeats its purpose and creates a cross-contamination route.
What AAMI PB70 level do LTC staff need?
Level 1 gowns suit minimal fluid exposure. For tasks with moderate fluid contact, a Level 2 gown provides a higher liquid barrier. Match the level to the task, not to the cheapest option.
Why does gown design affect infection control?
Weak seams tear during doffing and expose skin; poorly placed ties make removal awkward and increase the chance of touching the contaminated surface. Gown quality directly supports correct PPE technique.
Schedule a donning and doffing drill this week. Watch your staff remove their gowns and correct the sequence on the spot. Then check what gown you are actually stocking. Order CliniEco Medical Level 2 isolation gowns in 50-packs and give your team a barrier that comes off the way it should.
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