The role of gowns in preventing nosocomial transmission of respiratory viruses: a systematic review

Background: During the COVID-19 pandemic, long-sleeved gowns were advocated as personal protective equipment for healthcare workers (HCWs). The purpose of gowns is preventing transmission of infectious agents via the uniform or arms during contact with patients and their surroundings. Gowns, however, entail a substantial burden; in costs, workload for HCWs, and generated waste. Aim: To evaluate the current knowledge regarding the use of gowns during care of patients with COVID-19 and other respiratory viruses to prevent nosocomial transmission. Methods: PRISMA guidelines were used to search five databases (Medline, Embase, Web of Science, Cochrane, Google Scholar) up to April 11th, 2023. Findings: The search identified 2667 potentially relevant studies, of which 30 were selected and divided into four categories. In 12 studies, contamination rates of gowns ranged from 0% to 77.5% (median: 1.43%). Three out of seven studies showed that virus remained infectious the longest on Tyvek coveralls and plastic gowns, and the shortest on cotton and polyester. Two out of seven studies found a protective effect between HCW protective clothing and infection of HCWs. Finally, three out of four studies concluded that short sleeves, cotton gowns, or no gowns provided the same level of protection as standard gowns. Conclusion: Viral RNA can be found on clothing, but it is unclear whether viruses are transmitted to HCWs and/or patients. Evidence for the protective effect of long-sleeved gowns over alternatives is still insufficient. Therefore, well-controlled and adequately powered laboratory transmission experiments that simulate real-life conditions are necessary.