Strategies for Conserving the Supply of Isolation Gowns

Conventional capacity strategies

Use isolation gown alternatives that offer equivalent or higher protection

Several fluid-resistant and impermeable protective clothing options are available in the marketplace for HCP, including isolation and surgical gowns. When selecting the most appropriate protective clothing, employers should consider all of the available information on recommended protective clothing, including the potential limitations.

Reusable (i.e., washable) gowns are typically made of polyester or polyester-cotton fabrics. Gowns made of these fabrics can be safely laundered after each use according to routine procedures and reused.

Laundry operations and personnel may need to be augmented to facilitate additional washing loads and cycles. Systems are established to:

• routinely inspect and maintain (e.g., mend a small hole in a gown, replace missing fastening ties)
• replace reusable gowns when needed (e.g., when they are thin or ripped)
• store laundered gowns in a manner such that they remain clean until use

Contingency capacity strategies

Consider the use of coveralls

Coveralls are less convenient to use in most healthcare settings. Their one-piece design covers the back and lower legs, in addition to arms and the front of the body, making them useful for situations in which vigorous physical mobility is anticipated (e.g., emergency medical services). If coveralls are used, the material and seams should be appropriate to serve the intended barrier function effectively. Facilities should anticipate challenges and potential hazards to staff related to doffing coveralls and should provide training and practice in their safe use and designated places for donning and doffing, before providing them for patient care.

In the United States, the NFPA 1999 standard specifies the minimum design, performance, testing, documentation, and certification requirements for new single-use and new multiple-use emergency medical operations protective clothing, including coveralls for HCP.

Use gowns or coveralls conforming to international standards

Current guidelines do not require use of gowns that conform to any regulatory standards. In times of shortages, healthcare facilities can consider using international gowns and coveralls. Gowns and coveralls that conform to international standards, including with EN 13795 high performance gowns and EN14126 Class 5–6 coveralls, could be reserved for activities that may involve moderate to high amounts of body fluids.

Use gowns beyond the designated shelf life for training

The majority of isolation gowns do not have a designated shelf life. However, consider using gowns that do and are past their designated shelf life. If there is no shelf-life information available on the gown label or packaging, facilities should contact the manufacturer.

Prioritize gowns for higher risk activities

In addition to use as part of Standard Precautions, if contact with blood or body fluids is anticipated, isolation gowns could be prioritized for higher risk activities including:

• Use with patients with suspected or confirmed infectious diseases spread by contact transmission when close and prolonged contact with the patient or their immediate environment is anticipated (e.g., dressing, bathing or showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, and wound care).
• Use with patients colonized or infected with emerging highly resistant organisms including Candida auris (C. auris), carbapenemase-producing carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas and Acinetobacter, and pan-resistant organisms for activities that involve close and prolonged contact with the patient or their immediate environment (e.g., dressing, bathing or showering, transferring, providing hygiene, changing linens, changing briefs or assisting with toileting, device care or use, and wound care).

Facilities can consider suspending use of gowns for endemic multidrug-resistant organisms (e.g., methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended spectrum B-lactamases (ESBL)-producing organisms). Note: the organisms that are considered endemic can vary in different regions.

Surgical gowns should be prioritized for surgical and other sterile procedures. If used for isolation purposes, the gown should be changed between patients and must be removed and changed if it becomes soiled, as per usual practices. Different areas of the surgical gown may provide different levels of barrier protection.

Crisis capacity strategies

Implement extended use of isolation gowns

Consider extending the use of isolation gowns (disposable or reusable) so that the same gown is worn by the same HCP when interacting with more than one patient housed in the same location and known to be infected with the same infectious disease (i.e., COVID-19 patients residing in an isolation cohort). However, this can be considered only if there are no additional co-infectious diagnoses transmitted by contact (such as Clostridioides difficile, Candida auris) among patients. If the gown becomes visibly soiled, it must be removed and discarded or changed as per usual practices.

Consider using gown alternatives

In situations of severely limited or no available isolation gowns, consider the following pieces of clothing as a last resort for as single use for patients under contact precautions. However, none of these options can be considered PPE, since their capability to protect HCP is unknown. Preferable features include long sleeves and closures (snaps, buttons) that can be fastened and secured.

• Disposable laboratory coats
• Reusable (washable) patient gowns
• Reusable (washable) laboratory coats
• Disposable aprons
• Combinations of pieces of clothing can be considered for activities that may involve high amounts of body fluids and when there are no gowns available.

Reusable patient gowns and lab coats can be safely laundered according to routine procedures.

• Laundry operations and personnel may need to be augmented to facilitate additional washing loads and cycles
• Systems are established to routinely inspect, maintain (e.g., mend a small hole in a gown, replace missing fastening ties) and replace reusable gowns when needed (e.g., when they are thin or ripped)

Re-use of isolation gowns

The risks to HCP and patient safety must be carefully considered before implementing a gown reuse strategy. Disposable gowns generally should NOT be reused, and reusable gowns should NOT be reused before laundering, because reuse poses risks for transmission among HCP and patients that likely outweigh any potential benefits. Similar to extended gown use, gown reuse has the potential to facilitate transmission of organisms (e.g., C. auris) among patients. However, unlike extended use, repeatedly donning and doffing a contaminated gown may increase risk for HCP self-contamination. If reuse is considered, gowns should be dedicated to care of individual patients. Any gown that becomes visibly soiled during patient care should be disposed of or, if reusable, laundered.