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PROTECT

Gowns, gloves & scrubs, explained plainly

What the AAMI gown levels actually mean, when nitrile beats latex, and the doffing order that keeps what's on your gown from ending up on your skin. Plain-language support — not medical or purchasing advice.

The three things people get wrong

Most floor staff already know how to put a gown on. Where it goes sideways is the detail: a Level 1 cover gown used where a Level 3 job needs it, a vinyl glove pulled for a blood draw, or doffing in the wrong order at the end of a 12-hour shift when you're running on fumes. None of that is a character flaw — it's what happens when nobody slows down to explain the why. So here's the why, in order. For the official guidance, your facility's infection-prevention team and the CDC, WHO and OSHA standards are the authority; this page just makes it readable.

4
AAMI PB70 barrier levels, lowest (1) to highest (4)
ANSI/AAMI PB70:2012
Level 4
the only gown level tested for viral penetration (ASTM F1671)
AAMI / Nelson Labs
3–5×
more puncture-resistant nitrile is vs. latex
Medtecs / industry lab testing
8–17%
of regular latex-glove users develop a latex allergy
FDA / reported HCW ranges

AAMI PB70 gown levels — what each one is actually for

PB70 rates a gown by how well it holds back liquid in its critical zones. Higher isn't always better — it's about matching the gown to the fluid risk of the task. When in doubt, go up a level, not down.

  • Level 1 — minimal barrier

    Little to no fluid risk: basic patient care, standard isolation, a cover gown for visitors. The everyday gown, not the gown for a mess.

  • Level 2 — low barrier

    Slight fluid risk: blood draws, suturing, ICU tasks, pathology lab work. Tested against light spray and soak-through.

  • Level 3 — moderate barrier

    Moderate risk: arterial draws, IV starts, the ER, trauma. More fluid, more pressure — this is where Level 1 gowns fail you.

  • Level 4 — highest barrier

    Long, fluid-intense procedures, surgery, suspected non-airborne infectious disease. The only level tested to resist viral penetration (ASTM F1671).

Doffing order — remove in this sequence

Improper removal is one of the leading ways frontline staff contaminate themselves. Donning goes gown → mask/respirator → eye protection → gloves. Doffing reverses the dirtiest items first. Take it slow; do hand hygiene wherever your protocol calls for it (the WHO Five Moments are your guide).

1

1. Gloves first

They're the most contaminated thing you're wearing. Peel glove-to-glove, then glove-to-skin, so the outside never touches your bare hands. Discard.

2

2. Eye protection (goggles or face shield)

Handle it by the strap or earpieces — the front is contaminated. Lift away from your face, don't drag it across. Reusable items go to disinfection.

3

3. Gown

Unfasten ties, then pull away from your neck and shoulders, turning it inside out as you roll it into a bundle. Touch only the inside. Discard.

4

4. Mask or respirator last

It protected your airway, so it comes off last and away from clean air. Handle by the straps/ties only — never the front — then remove and discard.

5

5. Hand hygiene — every time

Finish with hand hygiene, and do it between steps whenever your facility's protocol or the WHO Five Moments call for it. This is the step that ties the whole sequence together.

Nobody ever sat me down and explained the doffing order on day one. I learned it the hard way — gown off before gloves, glove cuff brushing my wrist. Once someone shows you the why, you never do it backwards again.
A charge nurse, night shift, Medical-surgical floor

Questions we hear on the floor

Is a higher AAMI level always the safer choice?

Not exactly — it's about matching the gown to the task's fluid risk. A Level 4 gown for routine care is hot, wasteful and harder to move in; a Level 1 gown in a trauma bay leaves you exposed. The rule of thumb most teams use: when genuinely unsure, go up a level. Your infection-prevention team sets the standard for your unit.

Why has nitrile largely replaced latex?

Two reasons. Nitrile is 3–5× more puncture-resistant than latex and handles oils and weak acids better. And 8–17% of people who regularly use latex gloves develop an allergy to them — the FDA notes synthetic gloves like nitrile are safer for those individuals. Note that nitrile can still cause chemical-type skin reactions in some people, so it's not allergy-proof for everyone.

Can I use vinyl gloves for a blood draw if that's what's stocked?

This page is educational, not clinical guidance — but the consensus is no. Vinyl breaks down and tears at high rates and isn't recommended where blood or pathogen exposure is possible. Flag the stock gap to your manager; running out of the right glove is a supply problem, not a reason to use the wrong one.

What does 'Level 4 tested for viral penetration' actually mean?

Levels 1–3 are tested against liquid spray and soak-through pressure. Level 4 adds ASTM F1671, which challenges the fabric with a virus-sized surrogate under pressure. It's why Level 4 is the level called for when a non-airborne infectious disease is suspected.

Where's the official guidance if I want to go deeper?

The CDC's isolation-precautions and PPE pages, the ANSI/AAMI PB70 standard for gowns, OSHA's bloodborne-pathogens standard, and the WHO Five Moments for Hand Hygiene. Our <a href="/infection-prevention-guidelines">infection prevention overview</a> rounds them up in one place.

This is support, not a sales pitch

Feed The Line started by feeding frontline healthcare workers during the pandemic. Now we put plain-language explainers in your hands so the gear that protects you makes sense. No products to sell — just the people who never leave the floor, and the resources that have their back.