Frontline readiness to implement the consensus guidelines on sterile gowns for single‐shot spinal anaesthesia: a survey from Northern Ireland

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Recent consensus guidelines on the use of sterile gowns for single-shot spinal anaesthesia concluded that, in uncomplicated adults, the routine use of sterile surgical gowns should no longer be considered mandatory [1]. We welcome this proportionate, evidence-based position, which has the potential to reduce both financial and environmental costs without compromising patient safety. To gauge readiness to adopt this guideline, we conducted a survey involving anaesthetists across Northern Ireland. In total, 141 anaesthetists responded (73 consultants; 12 specialty and associate specialist doctors; and 56 resident doctors) out of a potential 392 anaesthetists working in Northern Ireland (201 Consultants, 51 specialty and associate specialist doctors and 140 resident doctors) [2]. There were 118 (84%) respondents who reported that they always wear a sterile gown in their current practice. Awareness of the new guidance was reported by 123 (87%) respondents. Attitudes regarding sterile gown use had already shifted in line with the recommendations: 25 (18%) respondents agreed that routine gown use should be mandatory, whereas 118 (84%) agreed that core aseptic practices matter more than the gown itself. Reported intention to change was hesitant. Asked whether, considering the guidance, they would stop using a sterile gown, 32 (23%) respondents answered ‘yes’; 76 (54%) ‘maybe’; 28 (20%) ‘no’; and 5 (4%) already did not gown. Eighty-two (58%) respondents still believed that gown use was mandatory under current local policy. There appears to be a significant dissociation with widespread awareness and attitudinal acceptance alongside a high incidence of continued use of sterile gowns. This suggests that principal barriers to implementation may not be the availability of evidence or belief, but instead, possible inertia or the deeply ingrained ‘ritual’ of gowning [3]. Three themes recurred in free-text responses. Equipment and logistics: the conventional gown pack is relied upon for its sterile hand towel, and respondents repeatedly noted that, without the gown, there is no means of drying the hands after a surgical scrub. Governance lag: many were unwilling to de-escalate barrier precautions until local infection prevention and control policy formally ratifies the national guidance. This was consistent with the majority who still perceive gowning as locally mandatory and are concerned about a lack of institutional support. Medicolegal anxiety: there remains a lingering fear of attributed blame should rare infective sequelae occur in the absence of a gown, despite the known incidence of such events [4]. We suggest that publication, although essential, may be insufficient to change behaviour. To assist departments to translate the guidance into clinical practice we propose that the working party consider recommending the following measures (Box 1). We hope these frontline data assist the working party as it monitors rollout, and underline that realising the benefits of this guidance will depend on coordinated implementation rather than publication alone.

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