Footwear Practices and Operating Room Contamination

Gina Copp, Linda Slezak, Nancy Dudley, Claire B. Mailhot

Use of protective footwear in the operating room (OR), that is, restricted shoes and shoe covers, is assumed to minimize the introduction of foreign bacteria from the outside environment into the OR. The purpose of this study was to determine if these footwear practices are effective in preventing transfer of bacteria into the clean area of the OR from outside environment. It is generally accepted that airborne contamination bears a casual relationship to surgical wound infection. Charnley and Eftekar (1969) demonstrated a correlation between the incidence of infective complications of hip surgery and the bacterial content of air in the OR. There is evidence to suggest that air contamination in the surgical environment is related to the redistribution of bacteria into the air from the OR floor. Hambraeus, Bengtsson, and Laurell (1978) estimated that up to 15% of bacteria found in the air originated by redispersal from the floor. The same authors showed that walking was a more important cause of bacterial dispersion than blowing or moping activities. It is to be expected, therefore, that traffic flow in the vicinity of surgical operations may constitute an important hazard in terms of increasing air contamination and potential wound infection.

An important source of floor and, thus, air contamination is related to contaminated footwear in the OR. A relationship has been shown between bacterial contamination of the floor and the footwear worn by OR personnel. Freshly cleaned areas of floor become contaminated by higher numbers of bacteria when walked on with contaminated shoes than when exposed to microorganisms only through air sedimentation (Hambraeus & Malmborg, 1979). Conversely, clean shoes become contaminated when they contacted areas of floor bearing a known microorganism; the same organism was subsequently isolated from the shoes (Barber & Dutton, 1965; Ritter, Sieber, & Carlson, 1984).