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The role of headwear and shoe coverings

When it comes to preventing the spread of disease or protecting yourself or others’ health, you’d never think twice about grabbing a pair of nitrile gloves or putting on a single-use face mask. But when it comes to protecting people and preventing contamination or transmission of infectious pathogens between environments, nearly any exposed surface is a potential threat.

If you stop at gloves and masks, you’re likely leaving other risks wide open. Headwear and shoe coverings, while often overlooked, are essential elements of comprehensive infection control protocols. When your plans are only as strong as your weakest point of protection, every aspect matters. In this guide, we’re going to look at the different types of headwear and shoe coverings typically encountered in the healthcare environment and discuss best practices and choosing the ideal PPE for your needs. Let’s get started.

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Reducing cross-contamination risks with shoe coverings

Shoe coverings are a simple, cost-effective means of protecting footwear and preventing patients, visitors, and healthcare providers from tracking infectious pathogens and other concerns into or out of the care environment. Typically made from polypropylene, these lightweight heavyweight covers slide easily over the wearer’s footwear and remain in place with the help of a thin elastic band. Available in a range of sizes, you can easily match coverings to a variety of footwear and ensure a secure fit for a wide range of ages and body types.

In addition to sizes, you’ll also find single-use medical shoe coverings available in multiple designs depending on the type of footwear you need to protect. Standard-cut designs are great for covering typical footwear, such as sneakers, cross-trainers, or high-grip work shoes. Should you need to protect larger footwear or cover gaps between gowns or pants and smaller shoe coverings, options are available that extend as far up as the knee with additional elastic enclosures to assure safe, effortless mobility and complete coverage.

Finally, most foot coverings are available with anti-skid options, which add a layer of high-grip treatment to the bottom — typically in a tread-like pattern — to help provide improved traction on various surfaces.

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Why use shoe coverings?

The most obvious benefit of shoe coverings is that they prevent people from carrying infectious diseases, bacteria, and other harmful particles on either the surface of their shoes or the underlying tread. Whether you’re looking for protection from splashed fluids or want to neutralize the risks posed by debris, spills, or fluids on the floor, shoe coverings provide full-coverage protection against most cross-contamination and soiling risks in the medical environment.

Most polypropylene shoe covers also offer decent splash and fluid penetration resistance, preventing staining and footwear damage on top of the health-related protective benefits. They’re affordable and easy to don and doff. Different options also help ensure a proper fit and optimal protection for patients young or old in everything from medical lobbies and common areas to highly-sensitive environments — such as the operating room or intensive care units.

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Proper donning, doffing, and disposal of medical shoe coverings

Following the recommended donning, doffing, and disposal instructions for PPE ensures optimal protection, reduces the risk of PPE damage, and minimizes exposure to any of the potentially hazardous materials collected on the shoe covering surface. Donning and doffing steps for shoe coverings will differ slightly based on design. Regardless of the design, all donning should start with removing the shoe covering from its packaging and allowing it to unfold. You should also ensure that you place your newly-covered shoe or boot into the clean environment after donning to prevent contamination.

Donning protective shoe coverings

1. Once you’ve prepared the shoe covering, simply slide the toe of your footwear into the extended section at the covering’s front with the seam, ESD strap, or grip design at the bottom.
2. Using a single finger, pull the remaining rear section up over the heel of your footwear.
3. If you’re using a shoe covering with electro-static discharge, be sure to place the strap from the shoe covering against your skin to allow for proper operation.

For a taller model, such as medical boot coverings, donning will differ slightly.

NOTE: Many boot coverings are designed for use with shoe coverings. Be sure to check recommendations for the model you intend to use before proceeding.

1. As with shorter designs, you’ll want to allow your boot covering to open fully.
2. Be sure to hold any ties or straps on the covering to prevent them from touching the floor or other surfaces as the boot covering unfurls.
3. Once the cover is secure on your footwear, pull the upper portion up behind your calf and allow the elastic to secure the covering.
4. Tie any ankle or calf ties by first wrapping the tie around your leg or foot to secure the boot cover and ensure safe movement while wearing.

Doffing protective shoe coverings

Properly removing your shoe coverings is just as easy and is an essential part of minimizing contamination risks.

For shorter models, such as medical shoe coverings:

1. Hook a finger under the cover at the highest point behind the heel.
2. Pull the back of the heel down, allowing the covering to unroll off the shoe.
3. Place your uncovered foot outside the clean environment.
4. Repeat for the second shoe.
5. Dispose of your shoe coverings in the proper receptacle.

For longer/taller covers, such as medical boot coverings:

1. Roll the upper section down, ensuring that the dirty surface rolls toward the inside to avoid skin or surface contamination.
2. Once rolled to the ankle and heel, use a finger to hook the heel portion and pull it away from the shoe.
3. Pull the covering down, allowing it to unroll off the shoe.
4. Place your uncovered foot outside the clean environment.
5. Repeat for the second shoe.
6. Dispose of your shoe coverings in the appropriate location.

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The protective benefits of medical headwear

Your hair is an important point to consider when protecting both yourself and the surrounding area from contamination. Not only is it a surface where potentially infectious materials might settle, but it’s an area you’re prone to touching if exposed.

This means you could easily transfer infectious bacteria, viral loads, or other materials from a contaminated or hazardous environment to your hair — or from your hair to another person! Hair coverings help combat this by encasing your hair in a protective barrier that keeps it safe from environmental threats and roaming hands.

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Choosing the proper headwear

Medical headwear typically comes in one of three general designs:

• Single-use surgical caps
• Bouffant caps
• Surgical hoods

Bouffant caps are the most common as they offer an ideal balance of easy donning and complete coverage for various hair types. However, surgical hoods and single-use surgical caps are more effective in certain situations.

As with most PPE, choosing the ideal design for your use case will offer better protection. It will also provide greater overall comfort and minimize any sort of distraction or interference — essential in critical situations such as surgical procedures.

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Bouffant cap pros and cons

As mentioned before, bouffant caps offer an excellent balance of ease of use and protection. Typically made of polypropylene, the caps simply sit around the hairline and remain in place reliably with no need to deal with ties.

They also include a pleated design that allows the cap to expand for extra room for additional hair without compromising fit. This means you can easily pull the bouffant cap over a bun or safely enclose larger amounts of hair. It can also pull down further, allowing for coverage of small sideburns.

This additional coverage and flexibility does come with some tradeoffs. Some people find the looser fit uncomfortable or distracting. There’s also the possibility of the cap touching or snagging on items within the environment, such as medical stands or lights. However, situational awareness will often alleviate most of these concerns.

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Single-use surgical cap pros and cons

Surgical caps (also known as skull caps or surgeon’s caps) are a popular alternative to bouffant caps. Their cloth counterparts were once far more common than single-use bouffants are today. They offer a snug fit thanks to ties and a sleek profile that makes them preferred by some. They won’t snag on environmental elements; are more comfortable to use with magnifiers, headlamps, and other head-mounted medical devices; and are resistant to shifting and riding up over time. However, this means they’re generally less effective (if not wholly unusable) for wearers with longer hair and will require more finesse when putting them on.

There has been an on-going debate in recent years as to whether skull caps offer better or worse protection than bouffant caps — with groups such as the Association of periOperative Registered Nurses (AORN), the American College of Surgeons (ACA), and the American Society of Anesthesiologists (ASA), all weighing in on the issue.

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Surgical hood pros and cons

Surgical hoods are the least common form of headwear used. They offer the highest protection level, both fully covering the head and wrapping down and around the face and neck. This makes them ideal for use in high-risk scenarios or when alternatives such as beard guards won’t work to protect facial hair. Typically made of polypropylene, these hoods offer both fluid penetration resistance and protect against settling aerosols or other concerns within the medical environment.

Obvious downsides include the full-coverage nature of the PPE. Having to wrap around the face and neck means the item will be more noticeable during wear and require greater effort and diligence when donning and doffing to avoid compromising the hood’s integrity and contaminating the wearer’s skin or the surrounding environment.

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Donning, doffing, and disposal of medical headwear

Donning and doffing steps may differ slightly depending on your headwear design and other personal factors such as hair length and style. However, the following steps should be an excellent starting point for safely donning and doffing most protective medical headwear types.

Donning bouffant caps or elastic surgical caps and hoods

1. Remove the bouffant cap from its packaging and hold it in front of you, allowing it to open.
2. Position the bouffant cap with the opening facing toward you and place your fingers inside the cap along the elastic edge.
3. Open the cap wide enough to fully clear your head and hair and pull it down over your head.
4. Remove your fingers, allowing the cap to snap into place, covering the ears.
5. If your hair is long, be sure the bouffant cap also encapsulates all hair. If necessary, place the hair in a bun of other compact style using a rubber band.

Doffing bouffant caps or elastic surgical caps and hoods

1. Tilt your head slightly and insert two fingers under the elastic band near the rear hairline.
2. Avoid touching the cap surface while doing so.
3. Gently pull away from the head, enlarging the cap or hood opening and pull it up and away from your head.
4. Without touching the cap, place it in the appropriate disposal receptacle.

Donning tied surgical caps and hoods

1. Remove the surgical cap or hood from its packaging and hold it in front of you, allowing it to open. Be sure not to let the tie straps touch any surfaces.
2. Tilting your head down, pull the surgical cap or hood over your hair with the ties toward the rear for caps and along the side for hoods.
3. Ensure that all hair is encapsulated.
4. If required, restrain hair in a compact fashion using rubber bands.
5. Tie the straps behind your head for caps or wrap loosely around your neck for hoods.

Doffing tied surgical caps and hoods

1. Using gloved hands, pull the tied or wrapped portion to loosen the cap.
2. Lift the cap or hood by the straps or pull away from the head.
3. Dispose of the used cap or hood in the appropriate receptacle and follow any required hand hygiene procedures to minimize contamination risks.

NOTE: Ultimately, regulations related to the medical environment and risk levels involved likely limit your PPE options. If you are unsure about the ideal headwear for a given situation, consult regulations to verify before proceeding.

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Key takeaways

• Headwear and shoe coverings work best when used alongside a comprehensive PPE selection.
• Shoe coverings are available in various sizes and coverage options to ensure safe movement and optimal coverage for a range of foot sizes and footwear types.
• Hair covering options include bouffant caps, surgical caps (or skull caps), and surgical hoods.
• Each headwear or shoe cover style offers a mix of ease-of-use, coverage, and comfort and should be matched with the required protection levels accordingly.
• Proper donning and doffing is essential to optimizing protection and minimizing exposure or cross-contamination risks.
• Always dispose of PPE properly to avoid contamination risks.

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As the respected quality leader in medical PPE, PRIMED’s range of single-use bouffant caps, surgical caps, surgical hoods, and medical shoe covers provide comprehensive, reliable protection for healthcare professionals on the frontlines of today’s ever-shifting healthcare environments. Contact us today to discuss how our secure supply chain, fully-owned manufacturing, and innovative PPE designs can protect the patients and professionals in your facility.

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