You have to wear a surgical gown. Period. Seem like common sense? It wasn't that long ago that surgeons were wearing suits and ties to operate, and when the first two-piece cotton gowns with elbow-length sleeves appeared, medical professionals debated whether to wear them. (The dawn of the sterile gloves, head covers and masks era was yet to come.)

Though originally intended to protect patients from healthcare-worker-transmitted pathogens, gowns now provide crucial protection for the OR team against patient-transmitted bloodborne pathogens such as hepatitis B (HPB) and C and HIV, according to the Occupational Safety and Health Administration, CDC's Hospital Infection Control Practices Advisory Committee (HICPAC) and AORN. Both roles are important and scientifically supported, they say. While rare, even small amounts of contaminated blood can strike through a scrub suit and be infectious, say researchers.

Unlike in the past, the challenge of surgical gown selection is not whether to wear one but, now, how to find one that incorporates comfort and protection. Here's what you should consider on both fronts.

The right fit
How comfortable is it? That's what surgeons, nurses and techs want to know about surgical gowns. Well, they're a lot more comfortable than they used to be. While developments throughout the 20th Century meant reusable medical textiles provided more impervious barriers to fluids, the surgical garb made from these rubber-impregnated muslins was hot and uncomfortable.

Such muslin saunas are no longer the norm, so the aspects that comprise a comfortable gown have become subtler. Features to look at when evaluating surgical gowns include the fit and feel of sleeve elastic; the cut, finish and closure of necklines; fullness in the arms and shoulders; and the cut of the long hemlines. All of these contribute to the fit and comfort of the gown.

You should also evaluate gowns for how they're packaged and the ease of unfolding and donning. Also, all sizes are not created equal - so when you obtain evaluation samples, ask for the complete range of sizes.

The right protection
"Moisture transfer rate," "water vapor transfer rate" and "microporous" are terms now seen on surgical gown promotional material. What that means, simply, is that protection no longer comes at the cost of comfort.

Your best bet, though, is to move beyond that jargon and start by determining what level of protection is required for various types of cases (see "Your Gowns' Protection Levels"), assessing which gowns meet those requirements, then obtaining pricing and product samples. If your facility is considering changing gown vendors, then ask for samples and presentations from all eligible vendors. Here are some barrier-protection features you might like to have.

• Extra protection. Gowns with plastic reinforcement are good for procedures that pose a more significant insult to fluids, such as orthopedics cases.
• Choice. If you like the fit and feel of a gown, you might want to have available both non-reinforced and reinforced versions of the same gown. That way, you can use the one appropriate to the procedure without sacrificing comfort. This is especially true if you're in a multi-specialty facility.
• Reusability. If you decide to launder your own surgical gowns, get quantifiable information from the manufacturer regarding the number and method of launderings.
• Breathability. Medical textiles have advanced to comprise breathable barriers that let body heat and moisture escape while preventing penetration by bacteria and viruses. Look for non-woven, composite-material gowns.

"When evaluating gowns and drapes, you'll be able to look at the amount of fluid on the field and how vulnerable the field is to splashes or sprays, as well as how much pressure is anticipated," says Fran Koch, RN, the administrative director of surgical services at Presbyterian Hospital in Dallas and co-chair of the AAMI Protective Barriers Committee.

The right balance
Occasionally there will be a facility that fails to reach a staff-wide consensus on surgical gloves, resulting in every doctor and nurse having their own private box of gloves - it is important that this not happen with gowns. Surgical gowns present a unique set of requirements that demand some uniformity in the facility. Unlike a compact box of gloves, sterile surgical gowns are bulky and hard to store. Inventory is expensive. Gowns are more specialized by barrier characteristics than are gloves. Even if restricted by your purchasing agreement, do your best to give more weight to the cost of gown inventory than the users' requirements.