Working in a 500-bed hospital, I see shoe covers worn by many people both inside and outside the Surgery Department. If you want to see the misappropriation of shoe covers, just go walk through the hospital’s cafeteria and you will see maintenance workers, custodian, physicians, interns and many other healthcare workers wearing blue, opaque paper shoe covers. I have seen healthcare workers and even physicians walking through hospital entrances coming to work, wearing these same shoe covers.  

I shudder when I see these “walking examples” of what not to wear. These are examples of things that give infection prevention experts and risk managers sleepless nights.

I wanted to have a discussion of “best practice” when it comes to shoe covers.

In the operating room or other areas such as the “clean room” for mixing IV solutions, the immunocompromised patient care areas such as bone marrow transplant, burn units, organ transplant, etc., this is the best practice: 

All workers in those units or departments should have a pair of shoes that “live” in that area. That means those dedicated shoes are not worn outside the unit unless they are covered with protective shoe covers. When a worker leaves the clean area, they slip on the shoe covers before leaving that sterile area. When the workers are working inside the clean/sterile area, they wear the dedicated shoes that should meet certain criteria. 

The dedicated shoes should be slip-resistant so that the workers are walking around the department with good rubber meeting the floor. If any water or wetness is on the floor, the slip-resistant shoes prevent slips and falls. 

The shoes should be completely enclosed (no clogs); no open-toed shoes or sandals; the tops of the shoes should not be absorbent (no cloth athletic shoes); and, if blood is reasonably anticipated in a surgery or other procedure, the worker must wear fluid-resistant shoe covers and remove them before leaving the operating room. 

Then, if and when they leave the sterile/clean area, shoe covers are put on to keep the dirt and soil from collecting on the dedicated shoes. Before re-entering the clean/sterile area, the soiled shoe covers are removed and the worker washes their hands before returning to work.

Does that make sense to you?  Share your best practice for the wearing of shoe covers inside and outside the operating room.


J. Darrel Hicks, REH, CHESP, is the author of "Infection Control For Dummies" and has over 30 years of experience in the jan/san industry. For a free 30-minute phone consultation, contact him at or through his website at