Putting on a sterile surgical gown follows a specific sequence designed to keep the outside of the gown uncontaminated from the moment you pick it up to the moment it’s secured. The process starts after you’ve completed a surgical hand scrub and dried your hands, and it ends with closed gloving. Every step matters because the gown is your primary barrier between your body and the surgical field.
Dry Your Hands Completely First
After your surgical hand scrub, dry your hands and forearms thoroughly with a sterile cloth towel before touching the gown. This sounds obvious, but residual moisture can compromise the antiseptic agents on your skin and make it harder to slide your arms through the sleeves. The specific drying technique you use is less important than making sure every surface is fully dry before you move on.
Picking Up and Unfolding the Gown
The gown will be folded on a sterile surface with the inside facing up. Reach down and grasp it through all layers with one hand, pinching only the inside top layer. This is the only surface you’re allowed to touch. Lift the entire folded gown and step back from the table so you have room to let it unfold without brushing against anything around you: the table edge, a cart, another person, the wall. Any contact with a non-sterile surface contaminates the gown and means starting over with a new one.
Let the gown drop open by gravity. If it doesn’t unfold completely on its own, a circulating nurse (who is not scrubbed in) can reach inside and pull the lower portion down for you. They should only ever touch the inner surface.
Sliding Your Arms In
Once the gown hangs open, locate the inside shoulder seams and orient the gown so the armholes face you. Slide both arms into the sleeves one at a time, keeping your hands at shoulder level and away from your body. Push your arms through until your fingertips reach the inside edge of the cuff, then stop. Pinch the inside seam at the cuff hem between your thumb and index finger to hold the cuff in place.
This is the critical detail: your fingers should not poke out past the cuff. Keeping your hands inside the sleeves is what allows you to use the closed gloving technique afterward. If your bare hand pushes through the cuff and contacts the outside of the gown, you’ve broken the sterile field.
Having the Gown Secured Behind You
You cannot fasten the back of the gown yourself without contaminating it, so a non-scrubbed assistant handles this. They grasp the gown at the inside shoulder seams, position it snugly over your shoulders, and fasten the neck and upper back. Most gowns use ties, hook-and-loop tabs, or snaps. The assistant’s hands stay on the inside surface only.
Tying the Wraparound Waist Tie
Most sterile gowns have a wraparound design at the waist secured by a cardboard tab holding two ties together at the front. Here’s the sequence:
- Separate the ties. Detach the cardboard tab from the short tie while keeping the short tie in your left hand.
- Hand off the tab. Pass the cardboard tab (still attached to the long tie) to your assistant. They walk the long tie around your back to your other side.
- Complete the wrap. Take the long tie from the assistant, and they pull the cardboard tab free. Tie both ends together in a bow at your waist.
This wraparound step is what creates the full sterile barrier around your torso. Until this tie is completed, the back of the gown is open and you are not fully gowned.
Closed Gloving Over the Cuffs
With your hands still inside the gown sleeves, you now put on sterile gloves using the closed gloving technique. Your fabric-covered hands work like puppets: you lay each glove on the corresponding cuff with the fingertips pointing toward you, thumb matching thumb. Then you use your covered fingers to fold the glove cuff over the gown cuff and slide your hand through. At no point does bare skin contact the outside of either the gown or the gloves.
Closed gloving is the standard for any procedure requiring a sterile gown because it eliminates the moment where an exposed hand could touch a sterile outer surface. Open gloving, where bare hands pull on the gloves directly, is reserved for situations where a gown isn’t being worn.
Which Parts of the Gown Are Actually Sterile
Not every inch of the gown stays sterile once you’re wearing it. The front of the gown between chest level and the height of the operating table is considered the most reliably sterile zone. Research measuring bacterial contamination at different gown locations found that this mid-section had the lowest contamination rates, while areas closer to the floor (below about 24 inches from the ground) and areas above the chest showed higher rates.
The sleeves are considered sterile from the glove cuff up to about two inches above the elbow crease. However, the elbow crease itself is a known trouble spot. Contamination rates at the elbows were significantly elevated compared to the mid-torso, so you should avoid letting your elbows contact the surgical field or any sterile surface. Contamination across all gown locations ranged from 6% to 48% in one study, which underscores why keeping your hands and arms in the safest zone, between your chest and the table, is so important throughout the procedure.
The back of the gown is never considered sterile, even with the wraparound tie in place. You cannot see or control what touches your back, so standard practice treats it as contaminated from the start.
Common Mistakes That Break Sterility
Most sterility breaks during gowning come from a few predictable errors. Letting the gown brush against a non-sterile surface while unfolding it is the most common, especially in tight spaces. Pushing your hands through the cuffs before gloving is another frequent mistake, particularly for people learning the technique for the first time. Reaching behind yourself to adjust the gown, crossing your arms below waist level, or letting your arms drop to your sides can all move your hands or sleeves outside the sterile zone.
Once gowned and gloved, keep your hands between chest and waist height at all times. Don’t touch your face, adjust your mask, or lean against anything. If you suspect any part of the gown has been contaminated, the safest response is to re-gown rather than to guess whether the contact was significant enough to matter.