Use of sterile gowns for single-shot spinal anaesthesia

Introduction

International guideline recommendations vary on the use of sterile gowns during spinal anaesthesia. There is limited evidence of benefit for their routine use and debate about environmental, financial and clinical costs and benefits. Updated, evidence-informed, consensus-based recommendations on the essential infection prevention measures for single-shot spinal anaesthesia are required to balance the need to maintain high standards of infection prevention with proportionate and sustainable practice.

Methods

A comprehensive literature review was undertaken to explore: the risk of infective sequelae; time to establish anaesthesia; infection prevention recommendations for the clinician performing the procedure and the assistant; and attitudes to infection prevention. This formed the basis for the development of statements and recommendations, which were considered in a modified three-round Delphi process.

Results

In total, 239 academic articles were identified, with 39 selected for full-text review. The review informed the development of 10 statements and 11 recommendations. Thirty-two professional experts and one patient representative completed all three rounds of the Delphi process. Consensus was reached on eight statements and 11 recommendations, including that the routine use of a sterile gown when performing single-shot spinal anaesthesia for uncomplicated adult patients (i.e. immunocompetent and/or for whom the procedure is expected to be neither difficult nor prolonged), should not be considered mandatory; two statements did not reach consensus.

Discussion

This consensus statement defines the essential aseptic measures for single-shot spinal anaesthesia in uncomplicated adult patients. While the routine use of sterile gowns should not be considered mandatory, core aseptic practices such as effective hand hygiene and facemask use are essential. These recommendations support a proportionate, sustainable approach to infection prevention. Clinicians may use this guidance to inform safe, evidence-aligned and environmentally responsible anaesthetic practice.