Wearing gloves, gowns, and face shields is considered the use of personal protective equipment, commonly known as PPE. In healthcare settings, these items fall under Standard Precautions, a set of infection prevention practices that apply to every patient interaction regardless of whether an infection has been confirmed. The CDC defines personal protective equipment as special coverings designed to protect the skin and the mucous membranes of the eyes, nose, and mouth from exposure to disease-causing organisms.
Why These Three Items Are Grouped Together
Gloves, gowns, and face shields each protect a different part of the body, and together they form a barrier against blood, body fluids, and infectious material. Gloves cover the hands, which are the most frequent point of contact with patients and contaminated surfaces. Gowns protect exposed skin on the arms and torso, along with the clothing underneath. Face shields guard the eyes, nose, and mouth from splashes, sprays, and droplets that could carry pathogens.
Not every patient interaction calls for all three. A simple blood draw might require only gloves, while a procedure like intubation, where splashing and spraying are likely, calls for gloves, a gown, and either a face shield or a mask paired with goggles. The decision depends on the type and degree of exposure anticipated.
Standard Precautions vs. Transmission-Based Precautions
Standard Precautions are the baseline. They assume that any patient’s blood or body fluids could be infectious and include hand hygiene, safe injection practices, and the appropriate selection of PPE based on the task at hand. Every healthcare worker follows these regardless of the patient’s diagnosis.
When a patient has a known or suspected infection that spreads through specific routes, additional layers called transmission-based precautions kick in. Contact precautions (for infections spread by touch) typically require gloves and a gown. Droplet precautions add a mask. Airborne precautions require a respirator. A face shield may be added to any of these when splashes or sprays to the face are possible. So when you see a healthcare worker wearing all three items at once, they are following Standard Precautions scaled up to match the risk of that particular task, or they are following transmission-based precautions for a specific pathogen.
Legal Requirements for Employers
PPE in healthcare is not optional. Under the Occupational Safety and Health Administration’s Bloodborne Pathogens Standard, employers must provide gloves, gowns, face shields, masks, and eye protection at no cost to employees whenever there is occupational exposure to blood or other potentially infectious materials. The equipment must be available in appropriate sizes, readily accessible at the worksite, and the employer is responsible for cleaning, laundering, disposing of, and replacing it as needed.
To be considered “appropriate,” the PPE must not allow blood or infectious material to pass through to the worker’s skin, eyes, mouth, street clothes, or undergarments under normal conditions of use. That standard is what drives the selection of specific gown levels and glove materials for different tasks.
How Gowns Are Rated
Medical gowns are rated on a four-level scale based on how well they resist fluid penetration. Level 1 gowns offer minimal water resistance and are suited for basic care with low risk of fluid contact. Level 2 gowns resist water spray and offer some protection under light pressure. Level 3 gowns provide moderate resistance. Only Level 4 gowns are tested against synthetic blood and viral penetration, making them the only gowns considered impervious to bloodborne viruses. Levels 1 through 3 are tested with water only, and because blood penetrates fabric more easily than water does, those lower-level gowns cannot be assumed to block blood or viruses.
What Face Shields Actually Block
Face shields reduce but do not eliminate exposure to respiratory droplets and splashes. Research testing face shields against simulated cough droplets found that designs offering the most wrap-around coverage, where the gap between the visor edge and the ear is smallest, provided the greatest protection across the eyes, nose, and mouth. However, no face shield completely sealed out all droplets. This is why face shields are often worn in combination with a mask rather than as a standalone substitute, particularly during procedures that generate aerosols.
Correct Order for Putting On and Removing PPE
The sequence matters, especially when taking PPE off. Contaminated gloves and gown surfaces can transfer pathogens to clean skin or clothing if removed carelessly. The CDC-recommended removal order is gloves first, then gown, then mask or face shield, followed by hand hygiene. Putting PPE on generally follows the reverse: gown first, then mask or face shield, then gloves, so the gloves can overlap the gown cuffs and leave no exposed skin at the wrist.
Getting this sequence wrong is surprisingly common. One review of over 300 healthcare worker interactions found 283 failures in precaution compliance, including entering patient rooms with incomplete coverings, being interrupted mid-removal, and accidentally touching contaminated surfaces without realizing it. Simulation studies have shown that up to 46% of participants contaminated their own skin or clothing during the removal process, and roughly 37% of healthcare workers’ hands were contaminated after removing gloves, with severity varying based on technique. Only about 34% of workers in one study demonstrated fully correct PPE use.
Common Barriers to Proper Use
Beyond technique, practical problems frequently undermine PPE effectiveness. Limited sizing options mean that one-piece coveralls often fit poorly, leaving petite workers in baggy gear that drags across surfaces, creates tripping hazards, and increases the chance of accidental contact with contaminated areas. Design complexity makes some equipment difficult to put on or remove quickly, particularly under time pressure. Prolonged wear causes discomfort from heat buildup, skin irritation, and restricted movement, all of which contribute to workers cutting corners or adjusting their equipment in ways that break the protective seal.
These issues highlight that PPE is only as effective as the training and infrastructure supporting it. Proper fit, accessible supplies in multiple sizes, clearly marked clean and contaminated zones, and regular practice with donning and doffing procedures all determine whether gloves, gowns, and face shields deliver the protection they are designed to provide.