ILLUSTRATIONS & LECTURES: GOWNING & GLOVING PROCEDURE

Figure 1

Placing arms in sleeves. (From Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis, 2010, Mosby.)

Figure 2

Circulating nurse ties scrub gown. (From Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis, 2010,
Mosby.)

Figure 3
Scrub nurse opens glove package. (From Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis, 2010,
Mosby.)

Figure 4

Glove applied as hands remain inside cuffs. (From Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis,
2010, Mosby.)

Figure 5A

A, Second glove applied. (From Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis, 2010, Mosby.)

Figure 5B
B, Gloved fingers extended. (From Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis, 2010, Mosby.)

Figure 6

Paper tab on disposable gown is passed to circulating nurse. (From Perry AG, Potter PA: Clinical nursing skills &
techniques , ed 7, St. Louis, 2010, Mosby.)
ALERT

Know institutional policy because double gloving may be recommended to reduce the risk for glove perforation during a
surgical procedure.

OVERVIEW

Immediately after surgical hand antisepsis, the nurse should apply a sterile gown and then apply sterile gloves. All
members of the surgical team must prepare in this manner before entering the sterile field. Once applied, the surgical gown
is considered sterile in the front from chest to waist or table level. The sleeves are considered sterile from 5 cm (2 inches)
above the elbow to fingertips. The back of the gown is not considered sterile when worn. Surgical gowns should cover all
garments worn underneath. All sterile gowns that are free of tears, punctures, stains, and abrasion provide an effective
barrier against microorganisms, particulates, and fluids passing between unsterile and sterile areas. 1

Use the closed-glove method to apply gloves when entering the sterile field. If a glove becomes contaminated during the
surgery, the circulating nurse, wearing protective unsterile gloves, grasps the outside of the glove and pulls off the glove
inside out, leaving the stockinette cuff of the gown in place. Another sterile team member assists in regloving. The open
method can be used when only one glove has been contaminated. In some settings the scrub nurse will wear two pairs of
sterile gloves. If both of the scrub nurse/technician’s gloves become contaminated, the nurse regowns and regloves using
the closed-glove method.

PATIENT AND FAMILY EDUCATION

 Instruct patient and family or significant other to observe surgical site for signs of infection.

ASSESSMENT AND PREPARATION

1. Select proper size and type of sterile gloves. Select latex-free gloves if the patient or any surgical personnel in
the room are latex sensitive.
2. Select proper size and type of sterile surgical gown.

Applying a sterile gown

1. Open sterile gown and glove package on a clean, dry, flat surface. Scrub nurse (before scrubbing hands) or
circulating nurse can do this, preferably on a small table separate from the sterile field containing the sterile
instruments and supplies.
Rationale: Provides sterile area for gloving.
2. If required during the procedure, apply cap, mask, eyewear, and shoe covers.
3. Perform surgical hand antisepsis. Dry hands thoroughly.
4. Pick up gown (folded inside out) from sterile package, grasping the inside surface of gown at the collar.
Rationale: The hands are not completely sterile. The inside surface of the gown will contact the skin’s surface and is
thus considered contaminated.
5. Lift folded gown directly upward, and step back, away from the table.
Rationale: Prevents gown from touching unsterile object.
6. Locate neckband; with both hands, grasp the inside front of gown just below neckband.
Rationale: Clean hands may touch inside of gown without contaminating the sterile outer surface.
7. Keeping gown at arm’s length away from body, allow gown to unfold with the inside of gown toward body.

Do not touch outside of gown or allow it to touch the floor.

8. With hands at shoulder level, slip both arms into armholes simultaneously ( Figure 1). Do not allow hands to move
through cuff opening.
9. Have circulating nurse pull gown over shoulders by reaching inside arm seams. Gown is pulled on, leaving
sleeves covering hands.
Rationale: Gown covers hands to prepare for closed gloving.
10. Have circulating nurse tie gown at neck and waist ( Figure 2). If gown is wraparound style, sterile front flap is not
touched until the scrub nurse/technician has gloved.
Rationale: Secures gown without contaminating it.
Applying gloves using the closed-glove method

1. With hands covered by gown cuffs and sleeves, open inner sterile glove package ( Figure 3).
2. Grasp folded cuff of glove for dominant hand with the nondominant hand.
3. Extend dominant forearm forward with palm up, and place palm of glove against palm of dominant hand. Gloved
fingers point toward elbow.
Rationale: Positions glove for application over cuffed hand, keeping glove sterile.
4. While holding glove cuff through gown with dominant hand on which it was placed, grasp back of glove cuff with
nondominant hand and turn glove cuff over end of dominant hand and gown cuff ( Figure 4).
5. Grasp top of glove and underlying gown sleeve with covered nondominant hand. Carefully extend fingers into
glove, being sure glove’s cuff covers gown’s cuff.
6. Glove nondominant hand in same manner with gloved, dominant hand ( Figure 5A). Keep hand inside sleeve. Be
sure fingers are fully extended into both gloves (Figure 5B).

Applying a wraparound gown

1. Grasp sterile front flap/paper tab with gloved hands, and untie.
Rationale: Front of gown is sterile.
2. Pass the sterile paper tab to a member of the sterile surgical team, or to a nonsterile team member (such as the
circulating nurse) (Figure 6).
Rationale: Nonsterile team member uses caution to prevent touching the sterile tie when taking the sterile paper tab
while the scrubbed health care personnel turns.
3. Keep gown tie in right hand. The circulating nurse stands still as the scrubbed health care personnel turns.
4. Allowing margin of safety, turn to the left one-half turn, covering back with extended gown flap.
5. Retrieve sterile tie only from team member, and secure both ties in place.
Rationale: Maneuver covers entire body with gown. Nonsterile team member pulls off paper tab and discards.

MONITORING AND CARE

1. Monitor patient postoperatively for signs of surgical wound infection (usually occurs 2 to 3 days postoperatively).
Signs of infection include redness, heat, swelling, pain, and purulent drainage.

EXPECTED OUTCOMES

 Patient will not develop signs of surgical wound infection.

UNEXPECTED OUTCOMES

 Redness, heat, swelling, pain, or purulent drainage develops at surgical site, which often indicates a wound
infection.

DOCUMENTATION

The performance of surgical hand antisepsis may need to be documented as part of operative note or check list of
procedure.

 Area of surgical site postoperatively

 Description of surgical site postoperatively
 Patient and family education

PEDIATRIC CONSIDERATIONS

 If child is awake, he or she should be told about gown application using an age appropriate explanation so he or
she can be prepared for the sight of a scrubbed team.
REFERENCES

Excerpted and adapted from Perry AG, Potter PA: Clinical nursing skills & techniques , ed 7, St. Louis, 2010, Mosby.