Purpose: Operating room (OR) shoe covers are widely used as part of surgical attire, despite uncertain evidence of benefit in preventing surgical site infections (SSIs). This scoping review aimed to evaluate whether OR shoe covers reduce environmental contamination or SSIs and to consider their clinical and environmental implications. Methodology: MEDLINE, Embase, Emcare and Scopus were searched for primary studies evaluating OR shoe covers in relation to bacterial contamination or SSIs. Eligible studies included quantitative or qualitative primary research conducted in operating room settings. Data was narratively synthesized. Results: Six studies met inclusion criteria, all from high-income countries. Five studies assessed environmental bacterial contamination and reported conflicting findings: two demonstrated lower colony-forming units with shoe covers, two showed no difference, and one reported higher contamination associated with shoe cover use. Only one study assessed clinical outcomes, reporting a reduction in SSI rates following reduced use of disposable perioperative attire, including shoe covers. No study demonstrated a direct reduction in SSIs attributable to shoe covers alone. Conclusion: Current evidence and international guidelines does not support the routine use of OR shoe covers for the prevention of SSIs. Given the lack of demonstrated clinical benefit, conflicting contamination data and the environmental burden associated with single-use OR shoe covers, routine shoe cover use should be strongly reconsidered. Further high-quality studies are required to inform evidence-based and sustainable perioperative infection prevention practices.