A Canadian long-term care home rebuilt its isolation gown order by matching every care task to a protection level instead of stocking one gown for the whole building. The review behind the change found light gowns in use for high-fluid tasks and heavier gowns pulled out for routine resident contact. The outbreak cartons were never the problem; the everyday line items were. This is a de-identified composite: the standards below are real, and the home's details are representative.
Why did the home audit its gown order?
A wound care nurse noticed that the gown worn for a dressing change looked the same as the one used to hand out meal trays. Two problems followed.
The first was protection. A gown cleared on a light spray test is not meant for a task where fluid can pool or soak through the fabric, and staff had no easy way to tell them apart in plain white cartons.
The second was supply. Level 3 and Level 4 gowns cost more per unit and were being consumed on tasks that never needed that barrier, raising the annual spend and leaving the critical-care cartons short during an outbreak. A third issue sat in the filing cabinet: the home could produce purchase orders, but not a written map from a care task to a chosen level. In Canada, provincial infection prevention and control guidance drives that reasoning.
How do PB70 levels map to care tasks?
ANSI/AAMI PB70, from the Association for the Advancement of Medical Instrumentation, sorts isolation gowns into four barrier levels, each tied to a laboratory method. Level 1 passes the AATCC 42 water spray test alone, for minimal fluid exposure. Level 2 adds AATCC 127 hydrostatic pressure resistance. Level 3 tightens that hydrostatic threshold, for moderate fluid. Level 4 adds ASTM F1671, which challenges the fabric with a bacteriophage to represent bloodborne pathogen penetration.
| Care task | Fluid risk | Suggested level | Illustrative annual units (200-bed home) |
|---|---|---|---|
| Meal assistance, bed-making, routine resident contact | Minimal | Level 1 | ~8,000 |
| Personal care, oral care, small splash potential | Low | Level 2 | ~12,000 |
| Wound care, emptying a urinary drainage bag, disimpaction | Moderate | Level 3 | ~2,000 |
| Aerosol-generating procedures, large-volume fluid, suspected viral haemorrhagic fever | High | Level 4 | ~600 |
The figures in the last column are illustrative, showing shape rather than a benchmark for another home. The level is set by the fluid risk of the task, not the price on the carton. Buying Level 4 for every task does not make a home safer, and it spreads confusion across the storeroom.
What changed in the line items?
Three shifts, and a fourth that stayed put.
The daily cartons moved to a Level 2 SMS isolation gown for resident contact, feeding and general personal care. It was the lightest gown that still carried hydrostatic pressure certification, covering low-fluid work at a lower cost. A Level 1 non-woven, fluid-resistant gown stayed for short, minimal-fluid tasks such as meal trays and bed changes.
Level 3 and Level 4 stock was not removed. It was separated, boxed by level and moved to the isolation carts, with a note naming the tasks that qualify. The reasoning behind those assignments is set out in the AAMI isolation gown levels procurement guide for Canadian healthcare.
Two questions drive each row: how much fluid can this task produce, and how long is the wearer exposed? Once those answers are clear, the level follows.
How did ordering and storage change?
The home consolidated to fewer suppliers and moved its routine volumes onto a wholesale ordering schedule, with par levels set per resident unit rather than for the whole building. Isolation stores were labelled by level on the outside of every carton. Each order line now names a level, a size and a closure style, rather than a vague "isolation gown" entry that two suppliers would fill differently.
Record-keeping tightened as well. Gown receipts, level labels and the task map now live in the same folder as the home's other monitoring paperwork, tracked through the compliance log centre. Homes that also run on-site reprocessing extend the same discipline to sterilization records, and teams weighing a new readout system often gather evidence first through a rapid reader seed trial.
What should an LTC buyer re-check each year?
Five items, and none of them takes long.
- The task-to-level map, checked against current provincial infection prevention and control guidance and outbreak plan changes
- Whether higher-level cartons are being opened for tasks that do not call for them
- Unit costs and packaging counts, since a smaller pack at a softer price can raise the cost per gown
- Supplier paperwork confirming the gown's PB70 level and its tests, matched to the product code received
- Storage and labelling, so the right gown is the easy one to reach
Two comparisons help in the annual review. Our note on when Level 1 is enough defends the lower tiers against a reflexive upgrade, and a read of how PB70 levels are measured makes a supplier's test claim easier to check. Sizing matters too: a gown that gaps at the back covers less than the label implies, so ask staff which sizes stay on for a full shift.
Related reading
- AAMI isolation gown levels: a procurement guide for Canadian healthcare
- Disposable isolation gowns: when Level 1 is enough
- AAMI PB70 testing explained: how gown levels are measured
Frequently Asked Questions
Is a higher PB70 level always better?
No. PB70 levels describe barrier performance against fluid, and a task that produces little fluid does not need a higher barrier. Matching level to task keeps costs and storage sensible while leaving the higher levels for where they are called for.
What is the difference between Level 1 and Level 2 isolation gowns?
Level 1 passes the AATCC 42 water spray test only, for minimal fluid exposure. Level 2 adds AATCC 127 hydrostatic pressure resistance, which suits low-fluid tasks where a splash is possible.
Do isolation gowns sold in Canada have to meet PB70?
PB70 is an ANSI/AAMI consensus standard rather than a Canadian regulation. It is the reference most Canadian buyers and infection prevention teams use to describe gown performance, while provincial guidance shapes how they apply in practice.
How many isolation gowns should a long-term care home order each year?
There is no single number. Build the estimate from your own task map: count each care task per resident day, multiply by the residents who need it, and apply the level that task calls for. Any figure without that working is illustrative only.
Should a long-term care home use reusable or disposable gowns?
Both have a place. Disposable gowns deliver a stated level with no laundering step, while reusable gowns can suit low-fluid tasks where a validated laundry process exists. That decision belongs with infection prevention and control.
CliniEco Medical is a licensed medical device establishment (MDEL #35334).
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