Quick Summary: Long-term care (LTC) facilities in Canada go through a large volume of isolation gowns every shift, and the choice between Level 1 and Level 2 protection affects both resident safety and the facility's annual budget. This guide walks through AAMI PB70 barrier levels, SMS 40 gsm fabric science, and practical gown selection for Canadian LTC settings — including how many gowns a typical home should stock, what the PHAC Routine Practices framework expects, and where CliniEco's Level 2 SMMS gowns fit into a daily care workflow.
Why LTC Facilities Burn Through So Many Gowns
A 120-bed long-term care home in Ontario does not think about isolation gowns once a week. It thinks about them every time a resident needs contact precautions, every time a healthcare aide performs wound care, every time a resident is admitted with an unknown infection status, and every time an outbreak of influenza, COVID-19, or norovirus closes a unit to visitors. On a busy outbreak day, a single nursing unit can go through several dozen gowns before lunch.
That volume makes gown selection a procurement decision rather than a clinical footnote. Choose a gown that is too light for the task and staff double-glove, double-gown, or improvise with aprons. Choose a gown that is heavier than needed and the facility pays a premium for protection nobody on that unit requires. The practical question is not "which gown is strongest" but "which gown matches which task in our facility."
Across Canada, LTC infection prevention programs follow the federal Routine Practices framework published by the Public Health Agency of Canada (PHAC), which applies to acute care, long-term care, ambulatory care, and home care settings alike. The framework directs facilities to assess the risk of exposure for each care activity and select personal protective equipment (PPE) that provides a barrier appropriate to that risk. Isolation gowns are a core part of that barrier, and their performance is measured under AAMI PB70, the American National Standard that classifies protective apparel by liquid barrier performance.
AAMI PB70 Levels: What the Numbers Actually Mean
AAMI PB70 is the standard most medical gown manufacturers build to, and it divides protective apparel into four barrier levels based on standardized tests for resistance to liquid penetration. The higher the level, the more demanding the test the material must pass.
| Level | Test Basis | Typical Use |
|---|---|---|
| Level 1 | Water resistance (AATCC 42), minimal fluid exposure | Basic care, standard isolation, visitor PPE |
| Level 2 | Water resistance plus hydrostatic pressure (AATCC 127), low-to-moderate fluid exposure | Blood draws, wound care, LTC contact precautions |
| Level 3 | Higher hydrostatic pressure resistance, moderate-to-high fluid exposure | Emergency care, arterial lines, high-splash procedures |
| Level 4 | Viral penetration resistance (ASTM F1671), highest fluid barrier | Surgery, procedures with heavy fluid exposure |
For most LTC work — dressing changes, catheter care, contact isolation, incontinence care — Level 2 is the practical sweet spot. It blocks the splash and soak-through risk that matters in resident care without the cost or stiffness of a Level 3 or Level 4 surgical barrier. A Level 1 gown remains appropriate for low-risk tasks such as meal tray delivery during a respiratory outbreak or a short visit to a resident on droplet precautions where no body fluid exposure is anticipated.
The test methods behind these levels are standardized by ASTM. AATCC 42 measures water impact penetration; AATCC 127 measures resistance to hydrostatic pressure; ASTM F1670 measures resistance to synthetic blood penetration; and ASTM F1671 measures resistance to bloodborne pathogen penetration using a bacteriophage surrogate. For a facility buyer, the key takeaway is that "fluid resistant" on a box label means little until you know which level and which test the gown actually passed.
Level 1 vs Level 2 in a Canadian LTC Setting
Facilities that standardize on a single gown type usually standardize on the wrong one — either too heavy for most tasks or too light for the tasks that matter. A better approach is a two-tier system:
- Level 1 gowns for low-exposure activities: resident transfers, feeding assistance, linen handling, environmental cleaning support, and general contact precautions where splash is unlikely. CliniEco's disposable Level 1 non-woven gowns fit this tier and keep the per-unit cost down where protection demand is low.
- Level 2 gowns for tasks with real fluid exposure: wound dressing changes, catheter and ostomy care, incontinence care with heavy soiling, and any contact precaution where body fluids may be present. The CliniEco SMMS 40 gsm Level 2 gown is built for exactly this workload.
This two-tier system aligns with how PHAC describes risk assessment in Routine Practices: healthcare workers should choose PPE based on the anticipated interaction with blood or body fluids, not on a one-size-fits-all policy. In practice, a 120-bed home might keep Level 1 as the default stock at every nursing station and pull Level 2 gowns for wound care carts, treatment rooms, and outbreak carts.
SMS 40 gsm Fabric Science: What the Number Means
SMS stands for Spunbond-Meltblown-Spunbond, a three-layer non-woven construction used in medical protective apparel. The outer and inner spunbond layers give the fabric strength and a cloth-like feel; the middle meltblown layer provides filtration and liquid holdout. When a product is described as "40 gsm," it means the full SMS laminate weighs 40 grams per square metre — a mid-weight specification that balances barrier performance, breathability, and cost.
CliniEco's Level 2 gown uses an SMMS (Spunbond-Meltblown-Meltblown-Spunbond) construction, adding a second meltblown layer for improved fluid resistance while keeping the garment lightweight enough for staff to wear during a full shift. SMMS gowns are a common choice for Level 2 because the extra meltblown layer helps the fabric pass the AATCC 127 hydrostatic pressure test without the stiffness of a coated or film-backed material.
For LTC buyers comparing gowns, fabric weight is a useful shorthand but not the whole story. A 40 gsm SMS gown and a 40 gsm SMMS gown can perform differently under the same test because of how the meltblown layers are distributed. Ask the supplier for the AAMI PB70 test level and the specific test results — hydrostatic pressure in centimetres (AATCC 127) and water impact in grams (AATCC 42) — rather than relying on fabric weight alone.
Gown Use Scenarios in Long-Term Care: A Practical Matrix
| Care Scenario | Fluid Exposure Risk | Recommended Level | Typical Tasks |
|---|---|---|---|
| Meal delivery, social visits, unit rounds | Low | Level 1 | Droplet precautions, no body fluid contact expected |
| Transfers, repositioning, hygiene assistance | Low-to-moderate | Level 1 or 2 | Possible urine/soiled linen contact |
| Wound dressing changes | Moderate | Level 2 | Exudate, blood, irrigation splash |
| Catheter care, ostomy care | Moderate | Level 2 | Urine, feces, irrigation fluid |
| Incontinence care with heavy soiling | High | Level 2 | Stool, urine, wash water splash |
| Contact precautions, outbreak units | Variable | Level 2 | Multiple resident encounters per shift |
| Specimen collection with splash risk | Moderate | Level 2 | Blood draws, wound swabs |
This matrix is deliberately conservative. When in doubt, the standard practice is to escalate one level rather than risk exposure. A facility that keeps both Level 1 and Level 2 gowns in stock can match the task without burning money on Level 3 barriers that LTC rarely needs.
How Many Gowns Should a Canadian LTC Facility Stock?
Gown consumption in LTC depends on occupancy, acuity, and outbreak frequency, but a rough planning baseline helps. A mid-size home with 120 residents and two outbreak events per year typically uses between 150 and 300 gowns per week in normal operations, and that number can triple during an outbreak when contact precautions are applied to entire units.
A practical stocking rule for a 120-bed facility: keep a minimum of 2,000 Level 2 gowns on hand (about two weeks of normal use plus outbreak buffer) and 1,000 Level 1 gowns for low-risk tasks. Facilities that order in case quantities — for example, the 50-pack format from CliniEco — can track usage per unit and reorder on a schedule instead of emergency-buying during an outbreak, when prices rise and stock tightens.
Seasonal planning matters too. Respiratory virus season (typically November through April in Canada) and norovirus season both drive gown consumption. Facilities that replenish gown stock in October rather than waiting for the first outbreak notice will have the inventory they need at the prices they budgeted.
Compliance: PHAC Routine Practices and Provincial Expectations
PHAC's Routine Practices and Additional Precautions guideline is the federal baseline for PPE use in Canadian healthcare settings, and every province expects LTC homes to have gown supplies that support these practices. The guideline's core principle is that transmission risk varies by task and setting, and PPE should be selected accordingly — which is exactly the logic behind a Level 1/Level 2 two-tier gown program.
Provincial regulators add their own expectations. Ontario's Fixing Long-Term Care Act, 2021 and O. Reg. 246/22, for example, require homes to have sufficient PPE and supplies to protect residents and staff, and provincial inspectors routinely check PPE stockpiles and donning/doffing protocols during compliance visits. Similar expectations exist under Alberta's Continuing Care Health Service Standards and British Columbia's residential care regulations.
From a procurement standpoint, "compliant" means more than having gowns on site. It means the right level of gown is available for the right task, staff are trained to don and doff without contaminating themselves, and used gowns are disposed of as medical waste according to provincial requirements. Facilities that document their gown selection logic — the risk matrix, the levels stocked, the training record — are in a stronger position at inspection time than facilities that simply buy whatever was cheapest.
Donning, Doffing, and Waste Handling Basics
Even the most carefully chosen gown performs poorly if staff remove it incorrectly. PHAC's guidance and most provincial IPAC programs emphasize that doffing is the highest-risk moment in PPE use because contaminants on the gown surface can transfer to the wearer. The sequence matters: remove gloves first, then perform hand hygiene, then remove the gown by breaking the ties and peeling it away from the body without touching the outer surface, then perform hand hygiene again.
Used gowns from contact precautions and wound care belong in biohazard waste, not the regular trash. LTC facilities should keep red biohazard bags accessible at the point of care so staff can dispose of gowns immediately after doffing. CliniEco's red 30-gallon biohazard medical waste bags are a common match for LTC waste streams, and the facility's waste contractor determines whether bags must be double-bagged or placed in rigid containers depending on provincial rules.
Training frequency matters as much as training content. Homes that run a PPE refresher at the start of respiratory season and after every outbreak see fewer donning/doffing errors, which translates directly into fewer staff exposures and fewer resident-to-staff transmissions.
Cost Considerations for LTC Budgets
Isolation gown pricing varies widely by level, fabric weight, and packaging. Level 1 non-woven gowns typically cost less per unit than Level 2 SMS/SMMS gowns, and 50-pack case formats reduce both per-unit cost and reorder frequency. A facility that standardizes on case buying from a single supplier also simplifies its procurement: one supplier, one delivery schedule, one invoice line for gowns instead of spot purchases from three distributors.
For LTC homes with tight budgets, the savings from a two-tier program are real. If a 120-bed home uses 20,000 gowns per year and half of those tasks genuinely require Level 2 protection, keeping the other half at Level 1 saves a measurable slice of the annual medical supplies line — without any reduction in resident or staff safety. That is the argument to bring to the administrator who thinks "one gown for everything" is simpler. It is not; it is either more expensive or less safe.
Related reading
Frequently Asked Questions
What level of isolation gown does a Canadian LTC facility need?
Most LTC tasks that involve body fluid exposure — wound care, catheter care, incontinence care, contact precautions — are well served by Level 2 gowns under AAMI PB70. Level 1 gowns cover low-risk tasks like meal delivery and visitor PPE. A two-tier stock (Level 1 as the default, Level 2 for fluid-exposure tasks) matches PHAC's risk-based Routine Practices approach and keeps costs in check.
Is a 40 gsm SMS gown strong enough for daily LTC use?
Yes for Level 2 tasks, provided the gown actually meets AAMI PB70 Level 2 requirements. The 40 gsm SMMS construction used by CliniEco adds a second meltblown layer for fluid resistance while staying light enough for full-shift wear. Ask the supplier for AATCC 42 and AATCC 127 test results rather than relying on fabric weight alone.
How often should LTC staff change isolation gowns?
A gown should be changed between residents and whenever it becomes visibly soiled or wet. Under PHAC Routine Practices, gowns are single-use barrier items for contact and droplet precautions; reusing a gown between residents increases cross-contamination risk and is not an accepted practice in Canadian LTC.
Do isolation gowns need to be sterile in long-term care?
No. Sterile gowns are required for surgical and invasive procedures, not for routine LTC care. Non-sterile Level 1 and Level 2 gowns are the appropriate choice for resident care, and they cost a fraction of sterile surgical gowns. What matters is the barrier level, not sterility, for these tasks.
Can Level 1 gowns be used for wound dressing changes?
Not ideal. Dressing changes can involve exudate, blood, and irrigation fluid, which puts them in the low-to-moderate fluid exposure category where Level 2 provides the safer barrier. If only Level 1 gowns are available, add a plastic apron or use additional fluid-resistant protection for the task.
What does SMMS 40 gsm mean on a gown label?
SMMS describes the non-woven structure: Spunbond-Meltblown-Meltblown-Spunbond. The two meltblown layers improve fluid holdout. "40 gsm" means the full laminate weighs 40 grams per square metre. It is a mid-weight specification common in Level 2 medical gowns.
How should used isolation gowns be disposed of in LTC?
Gowns worn for contact precautions, wound care, or any task with body fluid exposure should go into red biohazard waste bags. LTC homes should keep biohazard bags at the point of care and follow their waste contractor's requirements, which may include double-bagging or rigid container placement depending on the province.
Where can Canadian LTC facilities buy compliant Level 2 gowns in bulk?
CliniEco Medical supplies Level 2 SMMS 40 gsm isolation gowns in 50-pack cases and Level 1 non-woven gowns for lower-risk tasks. Bulk orders ship to Canadian facilities, and the CliniEco team can provide product specifications, test standards, and pricing for LTC procurement. Contact the team through the CliniEco website for a quote tailored to your facility's usage.
Related reading: explore our long-term care and home care resources.
start with our underpad buying guide for absorbency, sizing and cost.
References
- Public Health Agency of Canada. Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings. canada.ca
- AAMI. AAMI PB70: Liquid barrier performance and classification of protective apparel and drapes intended for use in health care facilities. aami.org
- ASTM International. ASTM F2407: Standard Specification for Surgical Gowns Intended for Use in Healthcare Facilities. store.astm.org
- ASTM International. ASTM F1670: Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Synthetic Blood. store.astm.org
- ASTM International. ASTM F1671: Standard Test Method for Resistance of Materials Used in Protective Clothing to Penetration by Blood-Borne Pathogens. store.astm.org
- ASTM International. ASTM F1868: Standard Test Method for Sweating Guarded Hotplate. store.astm.org
- World Health Organization. Hand Hygiene in Health Care. who.int
- World Health Organization. Health-care waste fact sheet. who.int
- Antimicrobial Resistance & Infection Control (ARIC). link.springer.com
- Infection Control & Hospital Epidemiology (ICHE). cambridge.org
- American Journal of Infection Control (AJIC). sciencedirect.com
- Journal of Hospital Infection (JHI). sciencedirect.com
- CMAJ. cmaj.ca
- CDC. Isolation Precautions and Gowns. cdc.gov
- CDC. Emerging Infectious Diseases (EID). wwwnc.cdc.gov
Last updated: August 19, 2026. This article is for procurement and infection control guidance only and does not replace the advice of your provincial IPAC program or regulatory authority.
Related Reading
Explore more guides in this category:
0 commentaire