Do Gowns Help Prevent Transmission of Respiratory Viruses?
August 15, 2025 4 minutes read
By Carol A. Kemper, MD, FIDSA
Synopsis: The authors examined various studies to look at the effectiveness of different kinds of gowns and materials in preventing viral infections. The results were mixed, with most studies demonstrating no good evidence that gowning helps in this regard.
Source: Orsel LM, Severin JA, Knoester M, et al. The role of gowns in preventing nosocomial transmission of respiratory viruses: A systematic review. J Hosp Infect. 2025; Jun 16. doi: 10.1016/j.jhin.2025.05.023. [Online ahead of print].
The benefit of contact precautions using gowns and gloves in preventing transmission of viral respiratory infection to healthcare workers (HCWs) and other patients has not been conclusively demonstrated. Only one study from the 1990s compared the use of gowns vs. no gowns in a real-life patient setting and found no difference in HCW respiratory syncytial virus (RSV) infection. And yet, contact precautions are recommended for most viral respiratory infections. Gowns are expensive, they have a significant carbon footprint, we go through thousands of them per day, and they increase the work burden for HCWs. They also may adversely contribute to the patient experience. Shouldn’t we prove they are really necessary?
These authors examined available databases for research studies pertaining to the use of gowns in the transmission of respiratory viral agents, finding 30 publications. Twenty of these were research trials; more than half (53%) were conducted in Asia; only five (17%) were conducted in the United States.
The studies were grouped into four categories:
Viral contamination rate on HCWs after patient care
Twelve publications were examined, 11 of which focused on SARS-CoV-2 and one on other respiratory viruses. These studies included 18 experiments using five different types of clothing materials, with varying HCW-patient contact for anywhere from 15 to 350 minutes. Polymerase chain reaction testing was used in all of the studies; only one performed viral isolation. Half of the studies found 0% viral particle contamination on gowns. Four of five studies performing cycle thresholds found very low viral loads. Only one study found a high rate of contamination (77%), where nurses submitted a large number of torso samples, but generally rates of contamination were low, e.g., torso (19%), shoes (15%), sleeves (12%).
Viral contamination of different types of fabrics in the laboratory setting
Seven studies were examined, six of which focused on SARS-CoV-2 and one on influenza A. All of the studies assessed viable virus in various types of fabric or clothing when inoculated with virus. The studies used various detection methods, but most used cultures with plaque assay for measuring viable virus. Generally, viable virus persisted longer on fluid-resistant materials and for less time on absorbent materials. For example, viable virus persisted on Tyvek gowns for up to seven and 14 days, and six days on plastic gowns. In contrast, viable virus persisted for up to three days and four hours on cotton fabric and only 2.5 hours on polyester. In another study, the combination of cotton and polyester performed the best, with only a small amount of SARS-CoV-2 virus found after 10 minutes compared with other materials.
Not wearing PPE and HCW infection
Seven studies examined the use of personal protective equipment (PPE) in HCWs who reported illness compared with no illness. Four of these studies focused on SARS-CoV-2 and the other three focused on SARS-CoV-1. Six of these studies examined the use of gowns vs. aprons or coveralls vs. no gowns. Only one study found that not wearing PPE was associated with an increase in the frequency of HCW infection, but this was only statistically significant when HCWs were performing aerosolizing procedures. Most studies found no relationship between not wearing gowns — or breaches in using gowns — and HCW infection.
HCW illness when wearing different clothing materials in the patient care setting
Two studies simulated viral contamination by using ultraviolet (UV) fluorescent gel, finding that more UV substance was found on the bare arms of HCWs foregoing gowns but wearing short sleeves, although this was no longer the case when hand and arm hygiene was performed. Two studies focused on SARS-CoV-2 and RSV using plastic vs. cotton gowns. During a three-month period, no HCWs became ill with COVID when wearing a cotton gown. Further, over an eight-month period, there was no difference in the frequency of HCW illness when caring for patients with RSV with or without a gown.
Commentary
These studies provide a mixed bag of information on rates of viral contamination of different types of gowns and materials. Most studies found no good evidence for gowning up reducing the risk of transmission of viral respiratory illness to HCWs or other patients, and the rates of viral contamination when present on various clothing/gown materials are probably too small to be of concern. Currently, we follow recommendations for gowning with most respiratory viruses, generating a huge amount of inconvenience and waste. It would be good to have a proper study demonstrating this is without basis. The authors speculated that bare arms (short sleeves) with good hygiene was a reasonable alternative to gowns.
Carol A. Kemper, MD, FIDSA, is Medical Director, Infection Prevention, El Camino Hospital, Palo Alto Medical Foundation.
The authors examined various studies to look at the effectiveness of different kinds of gowns and materials in preventing viral infections. The results were mixed, with most studies demonstrating no good evidence that gowning helps in this regard.
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