Six societies agree the sterile gown is not mandatory for a single-shot spinal

Design

literature review feeding a modified three-round Delphi consensus across six national societies

Population

239 articles identified, 39 reviewed in full; 32 professional experts and one patient representative

Primary outcome

consensus on statements and recommendations for aseptic practice in single-shot spinal anaesthesia

Effect

consensus on 8 of 10 statements and all 11 recommendations, including that routine sterile gowns are not mandatory for uncomplicated adults

International guidance on gowning for spinal anaesthesia has been inconsistent for years, and the inconsistency has been expensive - in money, in waste, and in the time taken to establish a block. A working group drawn from the Association of Anaesthetists, the Royal College of Anaesthetists, the Obstetric Anaesthetists' Association, Regional Anaesthesia UK, the College of Anaesthesiologists of Ireland and the Australian and New Zealand College of Anaesthetists reviewed 239 articles, took 39 to full text, and put 10 statements and 11 recommendations through a three-round modified Delphi with 32 professional experts and one patient representative.

Consensus was reached on eight of the ten statements and on all eleven recommendations. The one that will be quoted is that routine use of a sterile gown for single-shot spinal anaesthesia in uncomplicated adults - immunocompetent patients in whom the procedure is expected to be neither difficult nor prolonged - should not be considered mandatory. Two statements did not reach consensus, which the document reports rather than hides.

What did not move is as important. Hand hygiene and facemask use remain essential, and the guidance defines the aseptic measures that are core rather than removing a layer of protection. The qualifier carries the weight: uncomplicated, immunocompetent, and not expected to be difficult or prolonged. A catheter technique, a patient who is immunosuppressed, or a block you already expect to take several attempts falls outside it.

• Apply the relaxation only to single-shot spinals in immunocompetent adults expected to be straightforward
• Keep hand hygiene and a facemask as non-negotiable - the guidance strengthens these rather than relaxing them
• Gown for catheter techniques, for immunosuppressed patients, and where you anticipate difficulty or a long procedure
• Check your own institution's infection prevention policy before changing practice - the local policy binds you, not this consensus
• Where you do change, record the change as a departmental decision rather than leaving it to individual practice

Why it matters

It resolves a long-standing disagreement between guidelines in the direction of proportionality, and names exactly which patients it does not apply to.

Don't overread it

Delphi consensus informed by a literature review, not new evidence of equivalent infection rates - and the exclusions are narrow.

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