The surgical gown is a health care professional's first line of defense against bloodborne pathogens in the OR. Today's gowns provide more barrier protection than previous varieties; however, as a fabric's imperviousness increases, its comfort and breathability can decrease. And when surgeons are under hot lights, in a high-stress environment, and within close contact of each other, comfort is as important as barrier protection. In this article, we'll provide some advice on how to choose gowns and introduce you to some of the newest gowns on the market.

General recommendations
Various organizations, including the Protective Barrier Committee of the Association for Advancement of Medical Instrumentation (AAMI), Centers for Disease Control (CDC), and the Association of Operating Room Nurses (AORN), have released guidelines for choosing surgical gowns. In general, they recommend choosing gowns with the following characteristics:

• Good barrier protection against microorganisms, dry particles, blood, and body fluids. Manufacturers who claim their gowns are "impervious" must use two standard tests to substantiate their claim-the American Society of Testing Materials (ASTM) F1670 and ASTM F1671. ASTM F1670 is a simulated blood penetration test and ASTM F1671 is a simulated viral penetration test. Impervious gowns are ideal for fluid-intense cases, such as orthopedics. You may want to purchase "non-impervious" gowns for cases where fluid protection is less of an issue. In these gowns, look for a high hydrostatic pressure rating to ensure that fluid will not soak through easily.
• Resistance to tears, punctures, fiber stains, and abrasions. There are three tests for durability. The grab tensile test measures the amount of force necessary to tear the fabric. The Elmendorf tear test starts with a small hole in the fabric and measures the amount of force required to make the tear continue. Finally, the Mullen burst test measures the amount of force required to make a protuberance, such as an elbow, burst through the sleeve.
• Low flammability, particularly when the gowns are used in environments where electrosurgical devices, lasers, and other heat sources are present. Most gowns have a NFPA (National Fire Protection Association) Class I flammability rating, meaning that if the gown catches fire, it takes at least 3.5 seconds for the flame to spread to a different part of the fabric. The longer the flame spread time, the slower the material burns.
• Low linting potential to prevent particles from entering a wound site.
• High comfort factor. The gowns should wick away moisture and perspiration and be roomy in the shoulders and sleeves.

A few choices to consider
SmartGown, the newest disposable gown from Converters, a business unit within Allegiance Healthcare Corporation, a Cardinal Health company, incorporates a breathable impervious membrane that responds to any increases in temperature. As the temperature rises, the material "swells" to allow more water vapor to be absorbed. If the water vapor content on the inside of the gown is higher than on the outside, it drives the evaporation to the outside of the gown. This is referred to as the moisture vapor transmission rate (MVTR). SmartGown can keep the wearer cool by increasing the MVTR by as much as 64 percent as body temperature increases.

SmartGown has passed the ASTM F1670 and ASTM F1671 tests for impervious barrier protection not only on the gown fabric but also on the main seam along the sleeves. The company uses a special sealing process that forms a continuous bond along the sleeves, so the material is as impervious as the gown fabric itself. This level of protection makes the gown ideal for fluid-intense cases, such as arthroscopies. The gown also has plenty of room in the shoulders and sleeves for maximum comfort.

Additional choices from Converters include the Optima and Trimax fabric disposable gowns, which offer soft breathable comfort and barrierprotection. Available in standard, fabric-reinforced and poly-reinforced versions, the Optima and Trimax gowns come in a wide range of protection levels in various sizes and styles. For more information, call Convertors at (800) 964-5227 or visit www.cardinal.com/allegiance.

MicroCool Surgical Gowns, from Kimberly-Clark, are impervious disposable gowns, designed for fluid-intense procedures, which feature the company's microporous technology. According to the company, this means that two soft layers of nonwoven fabric enclose a thin yet strong layer of breathable film that is designed to allow perspiration to pass through easily, keeping the wearer cool while providing protection from blood and body fluids. MicroCool gowns pass the ASTM F1670 and ASTM F1671 tests for imperviousness.

MicroCool Surgical Gowns feature an adjustable neckline, generous sizing and ample length for greater comfort and coverage, raglan sleeves for freedom of movement and thermally sealed sleeves to prevent fluid penetration. They come in a variety of sizes ranging from large to XX large.

Kimberly Clark also offers Ultra Surgical Gowns, which are made from the company's 4th generation SMS (spunbond meltblown spunbond) fabric. SMS is a polypropelene material that is low linting and provides excellent barrier protection. The Ultra line, which includes non-reinforced, fabric reinforced, zoned impervious, and completely impervious gowns, all feature a raglan sleeve design, generous cut, extra-wide reinforcement, thermally sealed sleeves and longer length for better coverage. For more information, call Kimberly-Clark at 800-kchelps or visit www.kchealthcare.com.

Precept Medical Products manufactures a complete line of disposable surgical gowns made from the company's UltraGard SMS fabric. The SMS fabric is said to give these gowns high tensile strength and good breathability. The gowns are available in non-reinforced, fabric reinforced and impervious reinforced versions.

The company's Extended External Impervious Reinforced, X-long Sterile Back Surgical Gown features an external reinforcement that goes midway up to the shoulder and in front down to the hem. The type of reinforcement depends on the type of gown slelected. Fabric reinforced gowns use SMS material; polyreinforced gowns use plastic. For more information, call Precept at (800) 438-5827 or visit www.preceptmed.com.

Medline's Prevention gown is an impervious disposable gown composed of SMS fabric. According to the company, the gown is especially designed for orthopedics cases and other fluid-intense procedures; it offers generous sizing and plenty of room to move. The company also offers the Eclipse Plus gown, a disposable gown that is lined with plastic in the "critical zones," including the chest panel and sleeves up to four inches above the elbow. These fluid-repellent gowns are said to be good for ENT cases or other low-fluid cases. For more information, call Medline at (800) MEDLINE or visit www.medline.com.