The Evidence on Shoe Covers

Decades of research contain surprisingly weak support for shoe covers in infection prevention. A scoping review examined studies across multiple databases, focusing on bacterial contamination and surgical site infection outcomes.

Results showed mixed findings on bacterial contamination. Some studies reported fewer colony forming units with shoe covers, whilst others found no difference or even higher contamination levels. Only one study assessed actual clinical outcomes.

That study reported fewer surgical site infections following reduced use of disposable PPE — including shoe covers. No study demonstrated direct SSI reduction from shoe covers alone (Soh et al., 2026).

PPE Theatre vs Evidence-Based Practice

We've been implementing policies based on theoretical risk rather than evidence-based practice. The shoe cover ritual feels protective, but research suggests it might be performance rather than prevention.

Some studies in the review found higher bacterial contamination with shoe covers. This may result from cross-contamination during donning and doffing procedures. This mirrors broader patterns in healthcare where well-intentioned practices persist despite weak evidence.

The research notes that single-use plastics in shoe covers add environmental burden whilst delivering questionable clinical benefit. The one study showing improved outcomes actually reduced disposable PPE use — suggesting less might genuinely be more.

Why This Matters for Theatre Teams

This research parallels conversations across all disposable PPE categories. If shoe covers lack evidence for infection prevention whilst creating environmental waste, what about other single-use items in our theatres?

The findings support evidence-based sustainability in healthcare. Previous research has shown cloth surgical caps outperform disposable bouffants for infection control whilst dramatically reducing environmental impact.

For theatre teams, this research provides leverage for evidence-based policy changes. When infection prevention protocols lack scientific support whilst creating unnecessary waste, we have both clinical and environmental reasons to reconsider.

The financial implications are substantial. Shoe covers represent millions of pounds in annual NHS spending on items that may provide no clinical benefit. Addressing surgical waste has become an environmental and economic imperative — and this research provides the evidence to support change.

Sources

• Soh, Q. R., Moffroid, H., Eaton, E., Isles, N., Marshall, C., Gillespie, B., & Dunne, B. (2026). Does the evidence support the use of operating room shoe covers to prevent surgical site infections? A scoping review. Antimicrobial Stewardship & Healthcare Epidemiology.