Skin Cleansing

[johnmccall]

OK, Maybe not the most exiting subject but here we go!

When I trained (## years ago!) at Glasgow SOC we swabbed the feet with 0.5 Chlorhex. in 70% IPA, whole foot, from toes to heel. Theory was we were physically removing contamination by swabbing and that the Chlorhex and IPA would do the bugs some damage.

What's the current guidance/ practice/ evidence to support skin cleansing before routine Podiatry treatment, where there may be a risk (oops) of penetrating the skin?

What do you all do folks?

Thanks, and best regards,

John

[LouiseKennington]

Hi John,
We are currently facing the same dilemma. It was customary to swab with Chlorhexidine until our infection control nurse told us (some 10 years ago) that this was not good as bugs mutated and developed resistance to the chemical. He said it was not necessary to swab clean feet but suggested soap and water for dirty feet! We rejected this as impractical and he allowed us to compromise with isopropyl alcohol 70%. Recently we have joined with another trust who have always swabbed with Chlorhexidine. When speaking to a new infection control nurse before christmas she said it was good practice to clean the feet with some (unspecified) preparation where there was a risk of breaking the skin.
In contradiction to that, while researching for a nail surgery protocol most evidence suggested that it was not necessary to swab before injection and if you did swab with alcohol it must be left for 10 minutes before injection.

I would be interested to here any evidence one way or the other....

Regards,
Louise

[Aquaped Foot Care]

Ihave found povidine/iodine a suitable bactericidal application (in solution with n/saline) and have had no infections as a result in ten years- your thoughts on this?

[johnmccall]

Yes, I find povidone iodine fine pre-op for invasive procedures (eg nail avulsions - I'm not a pod surgeon) but the colour can obscure the skin if I'm doing routine stuff like enucleating h/ds.
Our local infection control person has said we shouldn't use IPA because the commercial preps are not licenced in the UK as a skin cleanser. He doesn't give any scientific reason. Just that they're not licenced!

More thoughts, or some real evidence would be much appreciated.

Cheers
John

[Aquaped Foot Care]

Dear John, Povidone/Iodine( known in Oz as Betadine) IS licensed as a skin cleanser here so perhaps you should contact the appropriate body to get their act together so you can officially use it if you wish- good luck
Anita

[johnmccall]

Thanks Anita,
I agree there's no problem with the licence when using povidone iodine, it was the use of 70% IPA (Isopropyl Alcohol) as a skin cleanser that our guy was questioning. I'll disregard his comments until he, or someone, produces some evidence(!).
Cheers
John

[pamcnally]

Dear John,
In my years of experience as an infection control consultant, I have not encountered any negative feedback in regard to using Chlorhexidine e.g. Hibiclens- 4% Chlorhexidine in alcohol as a skin preparation. Iodine preparations e.g.Betadine I have not heard of any problems either except there is a higher risk of skin sensitivity with patients. I recommend that skin should be cleaned with something such as above where there is a risk in breaking the skin. The Infection control guidelines put out by the Australian health Ministers' Advisory Council(formerly the NHMRC in 1996) then recently revised Jan 2004 recommend these types of skin antiseptics. Also Betadine should not be used for deep wounds.
Trish McNally
Infection Control Consultant

[Sean Millar]

Hi Trish,
in my student years and years following as a locum practice in private practice and public health, there has been routine use of 70% isopropyl alcohol impregnated wipes. The wipes are used for foot swabbing prior to commencment of routine foot care. up until the last 12 months i have not taken the time to read the packaging, but it states not for skin disinfection. Is this purely a matter of sensitivity or is there something i am missing.
Further, the 70% alcohol base waterless hand washes are being promoted in the hospital setting as the new standard in hand cleansing during routine patient care. firstly is there the same risk of sensitivity, and secondly is this an appropriate solution to use on prepartion of the foot prior to routine care.

[tw199y]

well acording to FCA at the SGH in glasgow the alcohol waterless hand disinfection soln should only be used on physicaly clean hands, so i would say that it wouldn't be recommneded for use on feet.

[R.E.G]

On this thread
Does anyone use the attributes of 'spirit' to highlight the 'colour' of skin when debriding/ enuclinating callus?

[Robin Crawley]

Hi Reg!

Yes I do.

I use Hydrex Derma Spray as a pre-op.

Cheers,

Robin.

[Arztin]

I think that's a great idea. Just today I was telling a diabetic patient who
had an aggressive tinea plague on much of his plantar medial arch that he
needed to get rid of the old accommodative inserts in his diabetic shoes.
He did not have his socks today because he knew he was coming in to
see me. I debrided the thick callused tinea lesion as much as I could
without getting too close then clean the foot with alcohol before apply-
ing an antifungal cream copiously to the site. I then put on a stockinette
so that all my work would not be wasted. The patient promised to throw
out his old inserts and put an extra pair he has at home. But the next
time I see him (if he still has the tinea despite him using a fresh
tube of the cream I gave him) I will implement your technique especially
if I really want to remove ALL of the infected tissue and not contaminate
any inadvertent cuts.