Theatre Shoes — A Link in the Common Pathway of Postoperative Wound Infection?

Abstract

INTRODUCTION Operating department staff are usually required to wear dedicated theatre shoes whilst in the theatre area but there is little evidence to support the beneficial use of theatre shoes.PATIENTS AND METHODS We performed a study to assess the level of bacterial contamination of theatre shoes at the beginning and end of a working day, and compared the results with outdoor footwear. RESULTS We found the presence of pathogenic bacterial species responsible for postoperative wound infection on all shoe groups, with outdoor shoes being the most heavily contaminated. Samples taken from theatre shoes at the end of duty were less contaminated than those taken at the beginning of the day with the greatest reduction being in the number of coagulasenegative staphylococcal species grown. Studies have demonstrated that floor bacteria may contribute up to 15% of airborne bacterial colony forming units in operating rooms. The pathogenic bacteria we isolated have also been demonstrated as contaminants in water droplets spilt onto sterile gloves after surgical scrubbing.CONCLUSIONS Theatre shoes and floors present a potential source for postoperative infection. A combination of dedicated theatre shoe use and a good floor washing protocol controls the level of shoe contamination by coagulase-negative staphylococci in particular. This finding is significant given the importance of staphylococcal species in postoperative wound infection.

Surgeon's garb and infection control: What's the evidence?

“…Whether this was related to fallout from the shoes or increased human activity was not analyzed. Similar to Amirfeyz et al, 136 Copp et el 139 found increased rates of bacterial transfer to the OR floor from street shoes than from designated theatre-only shoes or shoes with covers. Again, the relationship of this to SSIs was not studied.…”

“…Modern ORs with high air turnover rates and laminar flow air systems supposedly minimize the chances of floor redispersal, although this has never been proven. 136 Clean appearance of shoes has been shown to be an unreliable method of determining bacterial contamination. 137 Many hospitals have no set cleaning protocols regarding shoes worn in the operatory, even if dedicated footwear is required.…”

“…137 Many hospitals have no set cleaning protocols regarding shoes worn in the operatory, even if dedicated footwear is required. 136 Only a limited number of studies exist regarding the use of dedicated operatory footwear at all. Amirfeyz et al 136 studied bacterial contamination of designated theatre-only shoes at the beginning and end of the day with outdoor footwear.…”

“…They found the presence of pathologic bacteria on all shoes with outdoor shoes being significantly more contaminated than theatre-only shoes at both the beginning and end of the day. 136 Relationship of shoe contamination to SSIs was not studied. The type of shoes worn (eg, clogs, sneakers, leather) was not part of the analysis.…”

Feasibility of using real-time optical methods for detecting the presence of viable bacteria aerosols at low concentrations in clean room environments

“…Redispersed floor bacteria make up a portion of the airborne bacteria concentration as well (Amirfeyz et al 2007). Persson et al (2003) showed these airborne bacteria may be killed by an antiseptic gas before reaching the surgical wound.…”