foot & Apple
Nursing Footcare Newsletter

   Working together to provide the best care!


                                                                                                                                         October, 2011 - Issue 5  
Hands-on Class

This is an ongoing program.  Dr. Julia takes only 4 students at a time for a full day of hands-on foot and nail care training.

This very popular program is offered twice a month at a facility near Seattle, Washington.  Students come in from around the Country for this special opportunity.


For more information go to www.shop.RainierMeded.com



Honor Roll

The following  RainierMedEd students have passed their WOCN Foot and Nail Certification Test:

Patty Kuhn
Cheri Burrel
Yvonne Martineau
Nancy Reid
Pat Conway
Ted Green 

Beverly Thrasher

Joan McMunn

 

Congratulations!!

 

 

If you've passed, too, please let us know so we can list you here on the Honor Roll!!
Greetings!
foot & Apple
   

Infection Control in Foot Care

 

 

 

In this issue of the newsletter I'd like to cover a very important topic. Infection control is of paramount concern in all of healthcare. It goes without saying that this needs to be standardized for those of us providing "routine" foot care services as well.

I have reviewed several sources of information on this topic of infection control in foot care. The Centers for Disease Control has a large posting on healthcare infection control. It targets many areas of healthcare but also includes foot care.  Another source is the Washington State Department of Health Infection Control Guidelines. They also have a section dealing specifically with foot care. Finally, Dr. Warren Joseph, who is an infectious disease specialist, has published quite a bit on the topic. I have included the links to those sites below. I encourage you to go on and review for yourself.

You can see in the synopsis which I have reprinted below, that general nail and callous care is considered "noncritical".   In short, according to the CDC and Dr. Joseph, unless there is a current infection or you draw blood during the care, the risk of infection transmission is minimal .  Therefore, you can disinfect your instruments in what they have defined as an "Intermediate Level Disinfection."  That includes Cidex or even bleach.

So review the information below and be sure that you are following the guidelines in this important aspect of your foot care practice.


Your friend, 

Dr. Julia

 

 
CDC Guidelines  

 

DISINFECTION AND STERILIZATION GUIDELINE

RECOMMENDATIONS FOR PODIATRIC PHYSICIANS

 

These guidelines and recommendations are based on current literature and Center for Disease Control (CDC) recommendations. The recommendations here are intended to offer general guidance for podiatric medical offices on infection control.

 

Noncritical Instrumentation:

Noncritical instruments are those that come in contact with intact skin or nails but not non-intact skin or subcutaneous tissue.

 

Virtually no risk has been documented for transmission of infectious agents to patients through noncritical items when they are used as noncritical items and do not contact nonintact skin and/or subcutaneous tissues. Low-level disinfectants can be used for noncritical instruments, but generally intermediate-level disinfection is recommended.

 

Examples include: Nail cutting instruments, nail burrs, scalpel handles used for debridement of hyperkeratotic tissue, etc.

 

Intermediate-level disinfection:

Intermediate-level agents destroy all vegetative bacteria, including tubercle bacilli, lipid and some non-lipid viruses, and fungi, but not bacterial spores.

 

Examples include phenolic, iodophor, alcohol, chlorine.

This document incorporates information from the CDC document:"Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008"

 

Above is quoted from Dr. Warren S. Joseph at:

http://www.leinfections.com/category/infection-control/

 

 

A point of clarification

 

 
The low or intermediate level disinfection which is stated in the references above is for routine nail and callous debridement. This does not include work on a foot with a current infection or where blood was drawn during the care. In a situation where there is a current infection present, you may wish to defer the routine debridement and refer the patient to a podiatrist for appropriate care. If there is no current infection but in the course of your treatment you create a nick or scratch that draws blood, you now move into a situation where higher-level infection control is required.

 

American Podiatric Medical Association
Guidelines

 

 

The information below is quoted directly from the infection control guidelines prepared by the American Podiatric Medical Association based on the CDC guidelines. This additional source of information further helps us define the issues. 

-----------------------------------------------------------------------------------------------

 

Semi-critical Instrumentation:

Semi-critical instruments contact mucous membranes or non-intact skin. These

include instruments used in debridement of ulcerations, abscesses or other nonintact

skin or subcutaneous tissues. Semi-critical items minimally require highlevel

disinfection using chemical disinfectants.

Examples include: Instruments used in debridement of ulcerations or abscesses such

as tissue nippers, curettes, dissecting scissors, etc.

 

High level disinfection:

High-level disinfection traditionally is defined as complete elimination of all

microorganisms in or on an instrument, except for small numbers of bacterial

spores. The FDA definition of high-level disinfection is a sterilant used for a shorter

contact time to achieve a 6-log10 kill of an appropriate Mycobacterium species.

 

Cleaning followed by high-level disinfection should eliminate enough pathogens to

prevent transmission of infection.

 

Glutaraldehyde, hydrogen peroxide, ortho-phthalaldehyde, and peracetic acid with

hydrogen peroxide are cleared by the Food and Drug Administration (FDA) and are dependable high-level disinfectants provided the factors influencing germicidal procedures are met.

 

 

Cidex Manufacturer's Statement:

 

 
"Cidex Plus solution is indicated for use as a High Level Disinfectant when used or reused, according to the Instructions for Use for up to a maximum of 28 days at 25 degrees with an immersion time of at least 20 minutes."
 

 

 Dr. Julia's Interpretation

 


So my interpretation after my research is this:

Foot care instruments that are used on feet with no infection  

and no bleeding...  You can use a 1:10 bleach solution for 20 min.  (Intermediate Level Disinfection) 

 


Foot care instruments that are used on feet where bleeding or a laceration has occurred need to be cleaned with Cidex for 20 minutes. (High Level Disinfection)

 

 

*******************************  

 

 

Note from Dr. Julia: 

I am not an infectious disease specialist. You need to check with your own infectious disease consultant or department for their interpretation of the recommended protocols.

 

 Resource Links 

 


Here are the links to the pages with more detailed information on this topic of infection control in routine foot care.
 
 
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