•Use of gowns and face masks for single shot spinal anaesthesia during elective and emergency obstetric care

•Rationale underlying the respondents’ choices (Figure 1).

•Willingness to perform spinal anaesthesia without a gown if supported by guidelines.

•439 members completed the survey, of whom 76% were consultants [332/439] (Figure 2). This represents a response rate of 24% [439/1861 active OAA members]. 80% of respondents practiced in England [353/439]; no significant regional variation in practice was seen (data not shown).

•92% [404/439] of respondents indicated that they routinely wear gowns for elective cases and 96% [421/439] routinely wear face masks (Figure 3). In emergencies, usage decreases slightly; 86% [377/439] wear gowns and 94% [412/439] masks. When comparing consultants vs. non-consultants, consultants were slightly less likely to use gowns in both elective (90% vs 97%) and emergencies scenarios (84% vs 92%).

•78% of respondents do not ask their assistants to wear any additional precautions whilst they are preparing equipment and medication for spinal anaesthesia in theatre. 8% request that they wear a mask (data not shown).

•Whilst 77% [326/421] of respondents cited infection control as their rationale for wearing a face mask, the rationale for gown usage was more mixed (48% [193/404] cited infection control, 49% [199/404] avoidance of medicolegal risk) (Figure 4). Among those who do not use gowns, in elective scenarios 70% felt they were unnecessary, whilst in emergencies, 47% cited time savings as their rationale (data not show).

•79% [348/439] of respondents indicated that they agreed [148] or strongly agreed [200] with the statement “If supported by a guideline, I would be willing to routinely perform spinal anaesthesia without a gown?” whilst 14% [63/439] disagreed [48] or strongly disagreed [15] (Figure 5).

 

Discussion

Most OAA members still routinely wear gowns and face masks whilst carrying out spinal anaesthesia, reflecting current UK guidance. 77% of respondents cite infection control as their rationale for wearing a face mask likely due to the well-documented link between oropharyngeal bacteria and post-spinal infectious complications (2). The benefits of gowning are less certain (hence the international variability), and this is reflected by around half of respondents reporting compliance with guidance as their main motivation for gown usage. This aligns with the significant majority of respondents agreeing that they would perform spinal anaesthesia without a gown. 

The rarity of post-spinal infectious complications effectively precludes the study of sterile gowns by randomised control trial. In the absence of direct evidence, professional consensus and pragmatic guideline development will be essential.

 

Conclusion