News & Blogs

• Jul-15 2026
• isolation gown

Donning & Doffing Mistakes That Compromise Isolation Gown Protection

The Hidden Dangers of Improper Isolation Gown Use: Donning and Doffing Mistakes That Compromise Protection

Isolation gowns serve as a critical line of defense in healthcare settings, protecting workers from exposure to infectious agents and bodily fluids. However, the mere act of wearing a gown does not guarantee safety. Research increasingly demonstrates that the processes of donning (putting on) and doffing (taking off) personal protective equipment are fraught with potential errors that can negate the gown's protective benefits and lead to self-contamination. Understanding these common mistakes is the first step toward mitigating risk and ensuring that healthcare workers receive the full protection they expect.

The Alarming Prevalence of Self-Contamination

Self-contamination during PPE removal is a significant and well-documented issue. According to a 2024 study published in Disaster Medicine and Public Health Preparedness, which examined 116 healthcare workers, approximately 78.5% of participants experienced contamination after completing the PPE doffing process [citation:8]. This high rate underscores that contamination is not a rare anomaly but a frequent occurrence in clinical practice. The study identified several contributing factors, including lack of prior infection prevention control training and certain physical characteristics, highlighting that both human factors and equipment design play crucial roles in safety [citation:8].

Furthermore, a 2018 study by researchers published in Antimicrobial Resistance & Infection Control found similar results, showing that contamination of healthcare workers' working clothes and the surrounding environment occurred frequently during PPE doffing [citation:1]. The study, which tested three different PPE ensembles, detected contaminations on surfaces such as rubbish bin covers, chairs, faucets, and sinks, demonstrating that the risk extends beyond the individual to the broader clinical environment [citation:1].

Critical Donning and Doffing Mistakes

Specific errors during the donning and doffing process consistently contribute to the high rates of self-contamination. A detailed observational study of hospital personnel published in the American Journal of Infection Control revealed that a majority of workers fail to follow CDC and hospital guidelines for PPE donning and doffing [citation:9]. The study observed that only 23% of the 48 observed individuals avoided overt actions associated with self-contamination, and nearly half (48%) potentially contaminated themselves during the doffing process [citation:9].

The most common errors observed included:

• Improper Gown Tying: Tying the gown in the front instead of the back, which is against CDC guidelines, was observed in 35.4% of cases. Another 14.6% did not tie the gown at all [citation:9]. This leaves the ties exposed to potential contaminants and makes the doffing process more hazardous.

• Incorrect Doffing Sequence: Failing to follow the correct sequence for removing PPE components can lead to contaminated surfaces touching the wearer's skin or clothing.

• Failure to Roll the Gown: 56.3% of personnel did not roll the gown into a ball during removal, a key step designed to contain contaminants and prevent them from spreading to the environment or the wearer [citation:9].

The Gown Itself: A Potential Point of Failure

While user error is a primary concern, the protective barrier itself can fail. The barrier performance of isolation gowns is not always consistent. A 2023 investigation published in the American Journal of Infection Control tested 22 disposable isolation gown models from 6 manufacturers for liquid and viral penetration resistance [citation:7]. The results were concerning: Seven of the 22 tested gown models (approximately 32%) did not pass liquid and viral penetration testing based on AAMI PB70 at the level claimed by the manufacturer [citation:7][citation:12]. Notably, the majority of these failures occurred at the seam and tie attachment areas, which represent critical weak points in gown construction [citation:7].

Fluid Strikethrough: A Breach in Protection

Fluid strikethrough, where liquid penetrates the gown material, is a tangible failure of the protective barrier. A 2025 study by ECRI researchers involving 211 healthcare worker respondents found that 34.3% had experienced fluid strikethrough during non-surgical procedures [citation:2][citation:4]. Of those who experienced this failure, a significant portion reported it happening on a weekly or even daily basis [citation:2]. The consequences of this are compounded by the fact that nearly half of the respondents who experienced strikethrough never reported the incident [citation:4]. This underreporting is often due to a lack of awareness that it is a reportable event, the assumption that it is "normal," or a belief that no actionable change will result from reporting [citation:2][citation:4]. This creates a dangerous cycle where systemic issues with gown performance remain unaddressed.

Mitigating Risk: The Role of Design, Training, and Standards

Addressing these issues requires a multi-faceted approach that includes improved product design, rigorous user training, and adherence to stringent quality standards.

Product Design and Quality: The evidence clearly indicates that gown design can contribute to self-contamination risk. The 2018 study by Guo et al. found that the overall contamination rate and protocol deviations were lower with certain PPE ensembles that featured simple ergonomic features and high-coverage designs [citation:1]. This highlights the importance of selecting gowns with thoughtful design elements that minimize the potential for error.

As a leading manufacturer of non-woven PPE and medical consumables with over 20 years of experience, Unimax Medical understands these critical design and performance challenges. With ISO, CE, and FDA certifications, our manufacturing facilities are equipped to produce isolation gowns that meet international standards such as AAMI PB70 (Levels 1-4) and EN 13795. By focusing on robust seam construction, reliable barrier materials, and ergonomic design, we aim to provide healthcare professionals with protective equipment that performs as expected, reducing the risk of both fluid strikethrough and user error.

Training and Protocols: The high rate of protocol deviations observed in multiple studies underscores the critical need for comprehensive and ongoing training. Research by Liu et al. (2024) found that prior infection prevention control training was a significant protective factor, substantially reducing the relative risk of contamination points [citation:8]. However, the 2025 ECRI research found that fewer than half of gown wearers feel adequately trained on proper selection and use [citation:2]. Training must move beyond passive online modules to include hands-on skill development and regular competency checks.

Adherence to Standards and Procurement: Healthcare facilities must prioritize purchasing gowns that are independently tested and conform to recognized industry standards like AAMI PB70 [citation:7][citation:12]. Procurement decisions should not be based solely on cost but also on the gown's documented barrier performance and the manufacturer's commitment to quality and compliance. As the research suggests, failing to do so can create a "false sense of security" for healthcare workers, trusting in a level of protection that the product may not actually provide [citation:2].

Conclusion

The scientific literature provides compelling evidence that the effectiveness of isolation gowns is frequently compromised by a combination of human error during donning and doffing and inherent failures in the gown's barrier performance. The high rates of self-contamination and underreported strikethrough incidents represent a significant and preventable risk to healthcare workers. By investing in high-quality, certified protective equipment from reliable manufacturers like Unimax Medical, implementing rigorous and practical training programs, and fostering a culture where failures are reported and investigated, healthcare institutions can significantly enhance the safety of their workforce.

References

1. Guo, Y. P., et al. (2018). Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission. Antimicrobial Resistance & Infection Control, 7, 157. [citation:1]

2. Haberland, K., et al. (2025). ECRI Research Shows When Isolation Gowns May Fall Flat. ARRAY (AAMI News). [citation:2]

3. Erukunuakpor, K., et al. (2025). Self-Contamination Risk and Failure Modes During High-Level PPE Doffing: A Comparison of Two Powered Air Purifying Respirator (PAPR) Hoods: A Pilot Study. American Journal of Infection Control. [citation:3]

4. ECRI Researchers. (2025). Clinical Experience with Disposable Isolation Gown Selection, Strikethrough, and Reporting. Biomedical Instrumentation & Technology, 59(1), 117–127. [citation:4]

5. Kilinc-Balci, F. S. (2023). Investigation of the barrier performance of disposable isolation gowns. American Journal of Infection Control, 51(12), 1401-1405. [citation:7]

6. Liu, Y., et al. (2024). Contributing Risk Factors to Self-Contamination During the Process of Donning and Doffing Personal Protective Equipment. Disaster Medicine and Public Health Preparedness. [citation:8]

7. Mulvey, D., et al. (2019). Frequent and Unexpected Deviations from Personal Protective Equipment Use Guidelines Increase Contamination Risks. American Journal of Infection Control. [citation:9]