Pre‐procedure

ActionRationale

1. 1.Show
   Prepare the area where gowning and gloving will take place. Open the gown pack with clean hands. Do not touch the inside of the package.
   To ensure that there is adequate room to don gown and gloves and to avoid contaminating either. E
2. 2.Show
   Wash hands using a surgical scrub technique with either antiseptic handwash or an alcohol‐based handrub. Ensure hands are dry.
   To both disinfect and physically remove matter and micro‐organisms from the hands (WHO [124], C).

Procedure

1. 3.Show
   Open the inner layer of the gown pack, if present (Action figures 4.28 and 4.29).
   To allow the gown to be removed. E
2. 4.Show
   Grasp the gown on its inside surface just below the neck opening (this should be uppermost if the gown pack has been opened correctly) and lift it up, holding it away from the body and any walls or furniture. The gown should fall open with the inside facing towards you (Action figure 4.30).
   To open out the gown while keeping its outer surface sterile. E
3. 5.Show
   Continue to grasp the inside of the gown with one hand. Insert the free hand into the corresponding sleeve of the gown, pulling the gown towards you until your fingers reach, but do not go beyond, the cuff of the sleeve (Action figure 4.31).
   To pull on the gown while keeping its outer surface sterile. E
4. 6.Show
   With the other hand, release the inside surface of the gown and insert that hand into the corresponding sleeve, again until your fingers reach but do not go beyond the cuff of the sleeve The assistant should help to pull the gown on and tie the ties, without touching any part of the gown other than the ties and rear edges (Action figure 4.32).
   To pull on the gown while keeping its outer surface sterile. E
5. 7.Show
   The assistant should open a pair of sterile gloves and present the inner packaging for you to take. Take the package with your hands inside your sleeves, and place it on the sterile area of the open gown package so that the fingers of the gloves point towards you (Actions figure 4.33 and 4.34).
   To prepare the gloves for donning while keeping them and the gown sterile. E
6. 8.Show
   Open the inner packaging of the gloves (Action figure 4.35). The fingers should be towards you, the thumbs uppermost and the cuffs folded over. Keeping your hands within the sleeves of the gown, slide the thumb of your right hand (still inside the sleeve) between the folded‐over cuff and the body of the right glove (Action figure 4.36). Pick up that glove. Grasp the cuff of that glove on the opposite side with the other hand (still inside its sleeve) and unfold it, pulling it over the cuff of the sleeve and the hand inside. Then push your right hand through the cuff of the sleeve into the glove (Action figures 4.37 and 4.38). Repeat the process with the left hand (Action figure 4.39). Adjust the fit once both gloves are on (Action figure 4.40). Once both hands are inside their respective gloves, there is no risk of contaminating the outside of the gloves or gown with your bare hands. Note: never allow the bare hand to touch the gown cuff edge or outside of the glove. Also, the gloves can be put on either hand first; simply exchange ‘left’ and ‘right’ in the description if you wish to put on the left‐hand glove first.
   To don the gloves while keeping their outer surface sterile and ensure that there is no risk of contaminating the outside of the gown. E
7. 9.Show
   If you need to change a glove because it is damaged or contaminated, pull the sleeve cuff down over your hand as you do so and don the replacement glove using the technique above.
   To minimize the risk of contaminating the gown or the sterile field. E
8. 10.Show
   Dispose of used gloves and disposable gowns as ‘hazardous infectious waste’, unless instructed otherwise by the infection prevention and control team.
   All waste contaminated with blood, body fluids, excretions, secretions and/or infectious agents thought to pose a particular risk should be disposed of as hazardous infectious waste. C
9. 11.Show
   Once gowned and gloved it is important to maintain sterility, so:

   • Never drop your hands below the sterile area at which you are working.
   • Never touch the gown above the level of the axilla or below the sterile area at which you are working.
   • Never touch an unsterile object.
   • Never tuck your hands under your armpits.
   To avoid contamination of the sterile field. The only part of the gown that is considered sterile is the area at the front between the axilla and the sterile area at which you are working. The armpits are a source of micro‐organisms. C

Post‐procedure

1. 12.Show
   At the end of the procedure, remove gown and gloves as a single unit by pulling the gown away from you so as to turn it and the gloves inside out (Action figures 4.41 and 4.42).
   To avoid cross‐contamination of hands. E
2. 13.Show
   Consign reusable gowns as infected linen according to local arrangements.
   To minimize any risk to laundry workers from contaminated items (HSE [62], C).
3. 14.Show
   After removing the gloves and gown, decontaminate hands.
   Hands may have become contaminated (NHS England and NHSI [82], C).