We need to implement shoe decontamination interventions!
But you carry them with you on the soles of your travelers shoes
"The Littlest Birds" - The Be Good Tanyas
I know we really shouldn't be looking for other interventions to reduce pathogen transmission in hospitals since we're too busy eliminating contact precautions at the moment. But I can't resist highlighting this recent systematic review on contamination of shoe soles from Tasnuva Rashid and colleagues published in Journal of Applied Microbiology.
The authors reviewed the published literature from 1946 through 2015 to identify studies evaluating (1) shoes as vectors for infectious pathogens and (2) evidence on possible decontamination strategies. Their extensive review identified 13 studies (10 cross-sectional and 3 longitudinal) for inclusion. Three studies were completed in hospitals. One study found MRSA and VRE on 56% of physician shoes before rounds and 65% after rounds. Two additional studies found significant contamination of operating theater shoes with pathogens including staphylococcus, streptococcus and bacillus species. It doesn't get any better when looking at shoes worn in the community with significant contamination by C. difficile (40%), Listeria spp., Salmonella spp., and E. coli. I won't even mention the contamination found on the shoes of folks that work with animals.
Possible interventions evaluated include placing chemical filled mats in OR and ward entry points and shoe covers. While the reviewed studies suggest possible benefits for these interventions, more studies are needed. Of course, you know where I'm heading based on my intro paragraph - we need to implement shoe covers and chemical mats immediately in all hospitals. The data is clearly just as compelling as eliminating contact precautions based on single center studies. Oh, and we can fund these new shoe-targeted interventions using the savings generated through the elimination of contact precautions. Awesome!