SELF/Perioperative Nursing/Donning Sterile Gown and Gloves

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This training module prepares healthcare workers to safely enter a sterile environment by eliminating transients and reducing resident microorganisms on the hands and forearms. It involves systematic hand scrubbing, aseptic drying, and donning sterile attire (gown and gloves). It emphasizes infection control, attention to detail, and sterile technique.

• Describe the indications for full surgical gowning and gloving, including when to use closed versus open gloving.
• Identify the essential supplies for gowning and gloving and explain how they are prepared on a sterile surface.
• Explain the sterile zones of the gown and the infection control principles that govern their use.
• Explain correct drying technique and the proper sequence for gowning and gloving.
• Describe when regowning or regloving is required if contamination occurs.
• Explain the correct sequence for removing gowns, gloves, and PPE to avoid contamination after the procedure.

Full scrub and gowning are required for all procedures where the sterile operative field will be entered, including open surgeries, invasive procedures involving major vessels or body cavities, and cases where sterile instruments will be handled directly. The gown provides a sterile barrier from waist to shoulders and along the sleeves, protecting both the patient and staff from cross-contamination. Even in minor cases, such as wound debridement or orthopedic pin removal, if there is risk of contact with an open surgical site, full gowning and gloving must be used.

The gowning process always follows a proper surgical scrub or alcohol-based hand rub. Aqueous antiseptic scrub (such as 4% chlorhexidine or 7.5% povidone–iodine) is the standard, but in low-resource settings, a validated alcohol-based hand rub containing 60–90% alcohol with 0.5–1% CHG can be used when water supply is limited and hands are visibly clean. The choice of scrub or rub must account for patient safety, staff skin tolerance, and local availability.

Contraindications to gowning are rare but important. Healthcare workers with untreated skin infections, open wounds, or dermatitis on the hands and forearms must not scrub into surgery, as these conditions increase bacterial shedding and compromise glove integrity. In such cases, the worker should assist in a circulating role rather than a scrubbed role until the condition is resolved. Substituting a gown for insufficient protection (e.g., using a thin apron for major abdominal surgery) is not acceptable, as inadequate barrier protection compromises asepsis and endangers the patient.

Finally, nurses must understand the difference between open and closed gloving. Closed gloving—where hands remain inside the gown sleeves until gloves are applied—is the standard for entering the sterile field, as it prevents contact between bare skin and glove exterior. Open gloving, where bare hands contact the inside of the glove, is reserved for specific situations such as minor procedures outside the operating room or when regloving during surgery. Recognizing which method is appropriate ensures protection is never compromised.

Supplies for gowning and gloving must be prepared before the scrub begins so that the nurse moves seamlessly from drying into donning. The essentials include a sterile surgical gown sealed in its sterile pack, sterile gloves in the correct size (packed separately), and a sterile surface such as the back table or Mayo stand on which to open and arrange them. Gloves must be chosen carefully in advance—too small risk tearing, while too large compromise dexterity and increase the chance of contamination.

The gown should always be opened by the circulating nurse and presented on a sterile field without the inner surface being touched. Similarly, glove packs must be opened with the sterile inner wrapper facing upward. The sterile Mayo stand can be used as the “landing zone” for these items if the back table is crowded. Once opened, these supplies must not be shifted unnecessarily, as rehandling increases the chance of contamination.

On the sterile table, items should be placed in a clear sequence of use. The sterile gown pack is positioned closest to the scrub nurse, with the opening flap oriented toward them so the gown can be lifted directly without crossing over other sterile items. The glove pack is placed next to the gown, aligned so that the right and left gloves are easy to identify during gloving. If multiple staff will scrub in, each nurse’s gown and gloves should be kept together in designated spots to avoid mix-ups.

In low-resource facilities, reusable cloth gowns may be used. These must be carefully checked for holes, tears, or moisture, as strike-through contamination invalidates their sterility. Gowns should be folded in a consistent manner so they can be lifted and donned without fumbling. If glove supply is limited, staff should confirm correct sizes before opening packs to avoid waste of sterile gloves. This careful preparation reduces delays and ensures the nurse can gown and glove smoothly after scrubbing.

The sterile gown is designed to provide a defined sterile zone, and understanding its boundaries is essential.

Only the front of the gown, from the waist to the shoulders, and the sleeves from cuff of the gown to just above the elbows, are considered sterile. The neckline, shoulders, axillae, and back are not sterile and must never be used to handle instruments or touch sterile fields. Maintaining awareness of these zones helps nurses position their hands correctly and prevents inadvertent contamination.

Hand hygiene remains fundamental. Even though the nurse is fully scrubbed, dried, and gowned, lapses such as dropping hands below the waist or letting forearms contact unsterile clothing break sterility and require regowning. Staff must also resist the temptation to adjust masks or goggles after gowning—such actions contaminate the sterile gloves and demand regloving at minimum. Infection control is preserved only when every action acknowledges the sterile/non-sterile boundary.

Contamination during gowning can occur in subtle ways. For example, if the gown touches an unsterile surface such as the floor or equipment during donning, the sterile barrier is compromised and the gown must be replaced. Similarly, if a glove tears during the procedure, the nurse must reglove immediately using an assisted method, or regown if the cuff and sleeve are also contaminated. The principle is that once integrity is lost, sterility cannot be regained by simple adjustment.

Infection control also extends to teamwork. The circulating nurse plays a critical role in tying the back of the gown and adjusting it without contaminating the sterile surface. The scrub nurse must keep their hands and arms inside the sterile field while allowing the circulator to fasten ties. Clear communication between sterile and non-sterile team members ensures the gown remains sterile and protective throughout the procedure.

Self-Assessment

Please complete the following: Quiz 1: Donning Sterile Gown and Gloves - ECSACONM

After the scrub, drying is performed using a sterile towel held open by the circulating nurse. The towel is applied in a strict one-way motion: from fingertips to elbow, never reversing direction. Each arm is dried with a separate end of the towel, which is discarded immediately afterward. This step is as critical as the scrub itself—any improper drying technique risks reintroducing microorganisms onto the cleanest areas of the hand.

Refer to Surgical Scrubbing - ECSACONM for more details on hand drying tecnique

When donning the gown, the nurse grasps only the inner surface of the gown, keeping hands inside the sleeves while slipping arms through. This prevents skin from contacting the sterile exterior. The gown is pulled on without allowing it to brush against the floor, table, or body. Once arms are positioned, the circulating nurse assists in pulling the gown over the shoulders and tying it securely at the back. The sterile front of the gown must remain untouched by non-sterile personnel throughout.

There are two main methods of donning sterile gloves: closed gloving and open gloving. Closed gloving is the standard method after donning a sterile gown and is preferred because it prevents the bare skin of the hands from ever contacting the outside surface of the glove. With hands kept inside the gown sleeves, the cuff of the glove is aligned over the gown cuff and pulled on using the fabric of the sleeve, ensuring that only sterile-to-sterile contact occurs. Open gloving, in contrast, is used when a gown is not worn (such as in some minor procedures) or when a glove needs to be changed intraoperatively without regowning. In this technique, the first glove is handled only at its folded cuff with the bare hand, while the second is donned by sliding the gloved fingers under the cuff of the remaining glove. Once gloves are in place, cuffs must be checked to ensure they overlap the gown sleeve completely, leaving no skin exposed. While faster, open gloving involves brief contact between skin and glove interior, which is why it carries a slightly higher contamination risk compared to closed gloving. Nurses must understand the indications and limitations of each method and choose the appropriate one depending on the procedure and stage of surgery.

During gowning and gloving, hand and arm positioning is crucial. Hands should remain in front of the body, above the waist, and in view at all times. Lowering the hands, reaching behind the body, or allowing sleeves to slip back exposes unsterile areas and requires regowning. The nurse should move directly from gowning to the sterile field, avoiding contact with doors, carts, or equipment along the way. If a scrubbed nurse must pass through a door, they do not touch the handle; the circulating nurse opens the door while the scrubbed nurse keeps their hands elevated at chest level to preserve sterility.

At the end of the procedure, the gown and gloves must be removed in a controlled sequence to prevent contamination from the soiled outer surfaces.

Removal begins with the gown: the circulating nurse unties the back, and the scrub nurse gently pulls the gown forward and down, turning it inside out as it is removed so that the contaminated outer surface is contained. The gown is then discarded into the designated receptacle, without shaking or compressing it, as this disperses microorganisms.

Gloves are removed after the gown, using the glove-to-glove, skin-to-skin method. The first glove is pinched at the cuff and pulled off, held in the gloved hand. The second glove is removed by sliding bare fingers under the cuff and peeling it away inside-out over the first glove, trapping both within the inverted glove. This prevents contaminated glove surfaces from contacting skin. Hands should then be washed or sanitized immediately after removal.

PPE removal does not end with gloves and gown. If goggles, face shields, or aprons were used, these must be taken off carefully without touching the front surfaces, which are considered contaminated. Cloth items such as reusable aprons or caps must be placed directly into designated laundry bins for sterilization. Disposable masks should be removed by the ties, never the front panel. Each step is intended to limit the transfer of microorganisms from protective barriers back onto the nurse’s skin or clothing.

By treating every surface as potentially infectious until discarded and completing each step in order, the nurse ensures that contaminants stay contained rather than carried onto skin, clothing, or into the next case.

In low-resource environments, the principles of sterile gowning and gloving remain the same, but adaptations are often required. Reusable cloth gowns may be standard; these must be inspected carefully for moisture and holes, and sterilized properly between cases. If sterile towel supplies are limited, a single towel may be cut into halves for drying two staff members, provided each half is handled separately and used only for one person. Alcohol-based hand rubs can substitute for interim scrubs when sinks are limited, but the first scrub of the day should always be performed with soap and water.

When staffing is short, the scrub nurse may need to prepare their own gown and gloves before scrubbing so that assistance after drying is minimized. In such cases, careful body positioning and deliberate movements are vital to avoid contamination without extra support. If glove sizes are scarce, the closest fit should be chosen rather than attempting to reuse gloves, which compromises both dexterity and sterility. These adaptations preserve the central principle: the sterile gown and gloves form the nurse’s final barrier before entering the operative field, and their integrity cannot be compromised.

Self-Assessment

Please complete the following: Quiz 2: Donning Sterile Gown and Gloves - ECSACONM

Cumulative Test

Please complete the following: Module Test: Donning Sterile Gown and Gloves - ECSACONM

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