The gown goes on first. According to the CDC’s standard donning sequence, the isolation gown is the very first piece of personal protective equipment (PPE) you put on, followed by the mask or respirator, eye protection, and finally gloves. Before touching the gown, you should perform hand hygiene with hand sanitizer or soap and water.
The Full PPE Donning Sequence
The CDC outlines four steps for donning PPE, and the order matters because each layer builds on the one before it:
- Step 1: Gown. Fully cover your torso from neck to knees and your arms to the end of your wrists. Wrap the gown around your back so no skin or clothing is exposed, then fasten the ties at the neck and waist.
- Step 2: Mask or respirator. Put it on and adjust for a secure fit. If you’re using a respirator, perform a fit check to confirm there are no air leaks around the edges.
- Step 3: Eye protection. Put on goggles or a face shield.
- Step 4: Gloves. Select gloves that fit snugly and pull them over the cuffs of your gown sleeves so that no wrist skin is exposed between the glove and the gown.
The gown comes first because it serves as the base layer. Everything else sits on top of or tucks into it. If you put gloves on before the gown, for example, you’d need to pull gown cuffs over already-gloved hands, risking tears or contamination. Placing the mask and eye protection before gloves also keeps your hands free and clean for adjusting the fit on your face.
How to Put the Gown On Correctly
Start by selecting a gown that fits your body. One of the most common donning errors observed in studies is choosing a gown or coverall that’s too large, which causes the fabric to drag on the floor and pick up contaminants. A gown that’s too tight, on the other hand, can restrict movement and tear at the seams.
Slip your arms into the sleeves and pull the gown up so it covers you from neck to knees. If the gown has thumb loops (small holes at the end of each sleeve), slide your thumbs through them. These loops keep the sleeves anchored at your wrists so they don’t ride up during patient care, and they create a continuous barrier that your gloves will later cover.
Reach behind your neck and tie or fasten the neck closure first. Then wrap the gown so it fully overlaps across your back with no gap, and tie the waist. Both ties need to be secure but not so tight that they restrict breathing or movement. The goal is complete back coverage: any exposed clothing or skin is a potential entry point for fluids or pathogens.
Gloves Over Gown Cuffs
The final step in the donning sequence, pulling gloves over the gown’s cuffs, is where the gown and gloves work together as a sealed system. Your gloves should extend far enough to cover the edges of the gown sleeves completely. This overlap eliminates the gap at your wrists where splashes or contact could reach bare skin. If you’re using thumb loops, the gloves go on over them.
A common mistake is failing to check the seal between glove and gown after pulling them on. Take a moment to visually confirm there’s no exposed skin or bunched fabric at the wrist area. In one observational study of healthcare workers, about 4% failed to inspect the glove seal during donning, a small but avoidable error.
Choosing the Right Gown Protection Level
Not all gowns offer the same barrier. The standard classification system uses four levels based on fluid resistance:
- Level 1: Minimal water resistance. Suitable for basic care situations with low risk of fluid exposure.
- Level 2: Low water resistance. Handles water spray and light fluid contact.
- Level 3: Moderate water resistance. Provides protection against heavier fluid exposure under sustained pressure.
- Level 4: Resistant to blood and viral penetration. This is the only level tested and rated as impermeable to viruses. Levels 1 through 3 cannot be considered impermeable to viral penetration.
The situation determines which level you need. Routine patient care with minimal splash risk calls for a Level 1 or 2 gown. Procedures involving significant blood or body fluid exposure, or care of patients with highly infectious diseases, call for Level 3 or 4. Your facility’s infection control guidelines will specify which level to use for different scenarios.
Reusable Versus Disposable Gowns
The donning steps are essentially the same whether you’re using a single-use disposable gown or a laundered cloth gown. The main practical difference is that reusable cloth gowns are more likely to have thumb loops built into the sleeves, while some disposable gowns have elastic cuffs instead. Either design works to anchor the sleeve at the wrist, but check which style you have before you start so you know whether to look for thumb holes.
Reusable gowns also tend to have fabric ties rather than adhesive closures, so you may need a colleague to help ensure the back is fully wrapped and tied securely, especially at the waist where it can be hard to reach and confirm full overlap on your own.
Common Mistakes During Gown Donning
Beyond choosing a gown that’s the wrong size, a few other errors come up repeatedly. Skipping hand hygiene before touching the gown means you transfer whatever is on your hands to the outside surface of a garment you’re about to wear into a patient’s room. Leaving the back partially open defeats the purpose of the gown entirely, since splashes don’t only land on your front. And rushing through the neck and waist ties often leads to a gown that loosens mid-procedure, requiring you to re-adjust with contaminated gloves.
Taking an extra 15 to 20 seconds to check each fastening point before moving on to the mask and eye protection saves time and reduces risk. The donning sequence is designed so that each step is completed and verified before the next one begins.