Hospital use of decontaminating mats

The efficacy of a range of hygiene measures for boot cleaning to protect natural vegetation from Phytophthora cinnamomi

Phytophthora cinnamomi is an oomycete found in the soil and capable of invading the roots of a wide range of host plants globally, potentially killing them and affecting the ecosystems they inhabit. This pathogen is often inadvertently dispersed in natural vegetation on the footwear of humans. A range of equipment is often provided or recommended to be carried for cleaning footwear in places where P. cinnamomi poses a threat to biodiversity. These are typically a brush for mechanically removing soil and/or a disinfectant for killing the pathogen. Despite their widespread use, to our knowledge, the majority of hygiene measures have not been experimentally tested for their efficacy. In the current study, we tested whether two types of brush and the two most widely used disinfectants (70% methylated spirits and benzalkonium chloride) were effective in removing the pathogen from boots. We tested the brushes and disinfectants in two soil types and two moisture levels. All hygiene measures were found to be better than doing nothing, although some were only effective with sandy or dry soils. Benzalkonium chloride was largely ineffective as a spray but highly effective when used in a footbath. Brushing did not improve cleaning when used with 70% methylated spirits. None of the hygiene measures was completely effective for cleaning boots that had been in wet loamy soil. Our findings have important implications for management of this threat because some recommended hygiene practices are not doing what they claim.

Shoe soles as a potential vector for pathogen transmission: a systematic review

Shoe soles are possible vectors for infectious diseases. Although studies have been performed to assess the prevalence of infectious pathogens on shoe soles and decontamination techniques, no systematic review has ever occurred. The aim of this study was to perform a systematic review of the literature to determine the prevalence of infectious agents on shoe bottoms and possible decontamination strategies. Three electronic bibliographic databases were searched using a predefined search strategy evaluating prevalence of infectious pathogens on shoe bottoms and decontamination strategies. Quality assessment was performed independently by two reviews with disagreements resolved by consensus. Thirteen studies were identified that supported the hypothesis that shoe soles are a vector for infectious pathogens. Methicillin-resistant Staphylococcus aureus, Clostridium difficile and multidrug-resistant Gram-negative species among other pathogens were documented on shoe bottoms in the health care setting, in the community and among food workers. Fifteen studies were identified that investigated decontamination strategies for shoe soles. A number of decontamination strategies have been studied of which none have been shown to be consistently successful at disinfecting shoe soles. In conclusion, a high prevalence of microbiological pathogens was identified from shoe soles studied in the health care, community and animal worker setting. An effective decontamination strategy for shoe soles was not identified. Studies are needed to assess the potential for contaminated shoes to contribute to the transmission of infectious pathogens.