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.
Keywords: Delphi technique; asepsis; cross infection; infection control; spinal anaesthesia; surgical attire.
What we did: We looked at research papers about infection prevention during spinal anaesthesia (an injection in the back used to make part of the body numb). We reviewed the evidence about infection risk, how long it takes to give the anaesthetic and what safety steps doctors and assistants should take. Using this information, we wrote a set of statements and recommendations. A group of experts and one patient then took part in several rounds of voting to agree on the final guidance.
Why did we do it: Different international guidelines give different advice about whether doctors should wear sterile gowns when giving spinal anaesthesia. There is not much clear evidence showing that gowns help prevent infection. There are also concerns about the cost, waste and environmental impact of using extra equipment. We wanted to create clear and balanced recommendations that keep patients safe while also being practical and sustainable.
What we found: After reviewing the evidence and discussing it with experts, most of the group agreed on the final recommendations. They agreed that wearing a sterile gown is not always necessary when giving a single spinal injection to adult patients with straightforward conditions. However, other important safety steps must still be followed, such as cleaning hands well and wearing a face mask. These steps help prevent infection while avoiding unnecessary use of equipment. The recommendations aim to support safe care while also being mindful of cost and the environment.
© 2026 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.