Introduction
Infection control protocols are followed to prevent environmental contamination by pathogens in operating rooms (OR) to reduce surgical site infections (SSI). Disposable shoe covers used by patients whilst waiting for day surgery, have the potential to contaminate the surgical table if unremoved prior to OR admittance. However, the use and removal of patient shoe covers is not dictated in infection control guidelines. We aimed to determine if disposable shoe covers could transmit bacteria from the day surgery floor to surgical bed sheets.
Methods
Clinical study: Polypropylene disposable shoe covers (n=40) were worn and walking in three locations in day surgery unit: patient waiting area (5 and 10 minutes), toilet (5 minutes) and corridor (5 minutes), on five separate days. Bacterial number and species attached to the shoe covers and subsequently transferred to bed sheets was determined by culture and 16s rRNA sequencing. Laboratory study: The rate of bacterial transmission from artificially contaminated polypropylene and polyethylene shoe covers to bed sheets for the common pathogens Staphylococcus aureus, S. epidermidis, Escherichia coli, Pseudomonas aeruginosa, Enterococcus faecium and Acetobacter baumani was determined.
Results
Clinical study: A wide range of bacteria and fungi were found contaminating shoe covers worn in the day surgery unit and in every instance some were subsequently transferred to bedsheets, albeit at a low transfer rate ranging from 1.2% to 5.2%. Staphylococcus species, including S. aureus were the principal bacteria transferred. Laboratory study: For the common pathogens tested, the transfer rate to bed sheets range from 6.9% to 15.1% for polypropylene and 7.5% to 17.7% for polyethylene shoe covers. S. aureus had the highest transfer rate.
Conclusion
We demonstrated that disposable medical shoe covers can transmit bacteria from floor to bed sheets as a potential risk for hospital acquired surgical infections. We suggest an infection control policy should be considered to prevent patients returning to their bed with contaminated disposable shoe covers as this simple measure may reduce theatre contamination and the number of SSI.