How to Prevent Infection in Podiatry Clinics and Stay Safe

Infection and injuries can occur in any healthcare setting, from the Operating Theatre to the optometrist, to aged care facilities. This blog will focus on podiatry clinics and how they can provide a safe environment for their staff and patients. Without further ado, here are four top ways to prevent infection in podiatry clinics.

1. Prevent Infection in Podiatry Clinics By Remembering Sharps Safety

Podiatrists regularly use scalpels to debride plantar callus (built up from pressure), remove non-viable tissue from wounds, enucleate corns and manage problematic nails.

Inappropriate handling of sharps (such as scalpels) is a major cause of injuries involving exposure to blood-borne diseases. Therefore, it is necessary for podiatrists to consider their policies for safe handling and the disposal of sharps, including the removal of scalpel blades.

The Australiasian Podiatry Council has come up with some recommendations to ensure that podiatry clinics comply with regulations and keep staff safe from sharps injuries. These include:

• Use instruments rather than fingers to retract tissues, grasp needles and load/unload needles and scalpels.
• Sharp instruments and equipment should not be passed by hand between podiatry workers; passage of sharp instruments may occur by using a puncture resistant basin or neutral zone and a verbal announcement.
• Sharps must be disposed of as close as possible to the point of use into a clearly labelled, puncture-proof container that conforms to appropriate regulations such as AS/NZS 4031 or AS/NZS 4261.
• AS/NZS 3825:1998 Procedures and Devices for the Removal and Disposal of Scalpel Blades from Scalpel Handles specifies that removal of the blade must occur using a single-handed technique. This requires the approved blade-removing device to be securely mounted to a surface so that the container does not need to be held by the other hand during blade removal.

Prevent Infection in Podiatry Clinics By Prioritising Hand Hygiene

Hand hygiene has been identified by the World Health Organisation (WHO) as the most important measure to avoid the transmission of harmful germs and prevent health care-associated infections. As a healthcare provider, podiatry clinics and podiatrists should take hand hygiene seriously.

The Community Infection Prevention and Control in the UK have produced guidelines for hand hygiene to prevent infection in healthcare settings such as podiatry. These include:

• Staff need to cover cuts and abrasions with waterproof dressings
• Staff are ‘bare below the elbows’, which entails;
  • Wearing short sleeved clothing or rolling sleeves up to the elbows
  • Removing wrist and hand jewellery.
  • Not having dermal piercings on the arm or wrist
  • Keeping nails clean and short, as long finger nails will allow a build-up of dirt and bacteria under the nails and impede effective handwashing
  • Keeping nails free from nail polish
  • Keeping nails free from acrylic and/or artificial nails as these can harbour micro-organisms, become chipped or detached
• Hand hygiene facilities should be available within a practise and not compromise standards by being dirty or in a poor condition. Handwash basins should not be used for any other purpose (e.g. decontamination of equipment), due to the risk of cross-contamination
• An antimicrobial solution should be used prior to an invasive procedure.

WHO has developed the ‘5 moments for hand hygiene’ (below) to prevent patients and staff acquiring infectious agents within healthcare settings.

Prevent Infection in Podiatry Clinics By Wearing Gloves

In addition to the hands-washing principles of hand hygiene, wearing gloves is a critical aspect of infection control and safety within healthcare settings. Gloves are considered to be part of podiatrists’ Personal Protective Equipment (PPE).

The Australiasian Podiatry Council’s recommendations for glove-use within podiatry clinics are:

• Gloves must be worn as a single-use item when undertaking procedures and for activities that have been assessed as carrying a risk of exposure to blood, body substances, secretions and excretions or contact with mucous membranes.
• Gloves must be removed and hand hygiene practised if the podiatrist need to access drawers, touch surfaces outside the treatment area or leave the room.
• Sterile disposable globes must be used for all surgical and sterile procedures
• When removing gloves, care should be taken not to contaminate the hands. After gloves have been removed, hand hygiene must be performed in case infectious agents have penetrated through unrecognised tears or have contaminated the hands during glove removal.

Prevent Infection in Podiatry Clinics By Cleaning Instruments Before Disinfection

Reusable instruments used during podiatric procedures must be disinfected and/or sterilised after use. The Centre for Disease and Control (CDC) recommend that prior to disinfection and sterilisation, instruments (such as nail nipper and burs) should be cleaned manually with the appropriate chemical cleaning agents.

An article regarding Infection Prevention and Control in the Podiatric Medical Setting explains that this is important to make sure that residual organic and inorganic materials (such as skin and dirt) does not reduce the effectiveness of the disinfection and sterilization processes.

Some general hints they provide are:

• Cleaning should be accomplished in clinical settings by mechanically scrubbing instruments with water and detergents or with enzymatic products, followed by rinsing and drying.
• Cleaning, disinfection, and sterilization should be performed in dedicated non–patient-care areas with staff wearing appropriate personal protective equipment (PPE).
• All environmental surfaces used for cleaning, disinfection, and sterilization should also be appropriately cleaned and disinfected before reprocessing instruments.

References:

1. Causby, R. S et al. (2017). “A qualitative evaluation of scalpel skill teaching of podiatry students”. Journal of Foot and Ankle Research, 10:21. http://jfootankleres.biomedcentral.com/articles/10.1186/s13047-017-0202-9
2. Australasian Podiatry Council (2012). “Infection Prevention and Control Guidelines for Podiatrists”. Australasian Podiatry Council and STEAM Consulting 2012, Australia. http://www.cdc.gov/hai/pdfs/guidelines/ambulatory-carechecklist_508_11_2015.pdf
3. World Health Organization (2009). “Hand Hygiene: Why, How & When?”. http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf
4. Community Infection Prevention and Control (2017). “Hand Hygiene”. Harrogate and District NHS Foundation Trust, United Kingdom. http://www.infectionpreventioncontrol.co.uk/content/uploads/2017/12/GP-07-Hand-hygiene-December-2017-Version-1.00.pdf
5. World Health Organization (2007). “My 5 Moments for Hand Hygiene”. http://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/
6. Centre for Disease and Control (2015). “Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care”. http://www.cpd.apodc.com.au/activityitem/download/5911/3648
7. Wise, M. E (2015). “Infection Prevention and Control in the Podiatric Medical Setting”. Journal of the American Podiatric Medical Association, 105:3. http://pdfs.semanticscholar.org/d4d6/f516e8b4b37d235b1d01ddcf00a9395b96e0.pdf