Are your theatre shoes harbouring hidden pathogens?

Infection prevention & control is a vital part of hospital life, but bacteria, viruses, and pathogens could be making their way into supposedly sterile environments hidden in the soles of theatre shoes and clogs.


Medical staff follow strict procedures when it comes to sterilising and disinfecting surfaces, equipment, and clothing, but footwear is often neglected. Some hospitals do not implement specific rules about how often theatre shoes should be disinfected, leaving it up to the individual employee to clean them as often as they see fit.


Research suggests this hygiene loophole could pose a health risk with evidence of dangerous bacteria found on the soles of shoes and clogs worn by doctors and other medical personnel. This is particularly concerning during a pandemic when extra precautions have been taken in all areas of hospitals to prevent the spread of coronavirus, but this area seems to have been forgotten. 


A 2020 report from the CDC – the health protection agency for the United States – studied doctors working in the Chinese city of Wuhan at the height of the Covid-19 pandemic. Samples were taken from the soles of shoes worn by medical staff working in intensive care units, and 50% of them tested positive for Covid-19.


This prompted researchers to warn and raise the alarm that shoes could actually transmit the virus from place to place, posing a potential health hazard. And this isn’t the first-time studies have highlighted the issue of bacteria being transmitted on surgical footwear.


Bacteria contamination

A Royal College of Surgeons of England report in 2007 assessed how much bacteria theatre shoes were contaminated with at both the beginning and end of a shift. It concluded that dedicated footwear for operating theatres, such as theatre shoes, and the floors themselves were a potential source of bacteria that could cause postoperative infections. However, it did note that allowing staff to wear their outdoor footwear posed an even bigger risk.


A 1993 study examined 200 different pairs of theatre shoes from three hospitals in South East Wales. It found the majority of the surgical footwear selected was dirty, and in one of the hospitals, 95% of the shoes tested were unclean.


And researchers found senior surgical staff were more likely to have dirty footwear than more junior employees. Evidence from one hospital revealed that 58% of theatre shoes worn by consultant surgeons were contaminated with blood, compared to half of those worn by junior surgeons and 16% of footwear belonging to operating department assistants.


In contrast, the theatre shoes worn by nursing staff contained no traces of blood. The report suggested the high levels of blood contamination posed a potential risk of spreading HIV and hepatitis B.



What’s the solution?

Medical staff currently use various methods to clean theatre shoes with varied results. This includes using disposable wipes, disinfectant sprays or soaking them in a sterilising solution.

But the results of these cleaning methods vary and if attempts to disinfect theatre shoes and clogs, are irregular and inconsistent, they will have little impact on infection control.


The Miele PG 8582 washer-disinfector can be used to disinfect the clogs after each use, killing all the bacteria and viruses trapped in the soles and leaving them germ free.


This particular model can hold up to 28 pairs of theatre shoes with the correct combination of the A310 and A307 custom inserts, allowing for them to be disinfected in the same way as medical equipment, reducing the spread of harmful bacteria.


The appliance first removes any protein soiling, including blood and bodily fluids, before disinfection is carried out at a material processing temperature of 93°C.


By installing an effective washer disinfector that has the capability of decontaminating surgical clogs and shoes and introducing a strict, regular cleaning procedure for theatre shoes, hospitals can reduce the spread of harmful bacteria.