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Just entered the world of bureaucratic pain by accepting a job to start the Podiatry service for a Large Non for Profit community aged care provider.

Currently foot care is provided by Nurses with no additional training...this stresses some of them. They restrict treatment to nail debridement.

My concern is that they use non sterile clippers on patients with obvious compromised immune systems since they regularly deal with elderly and patients undergoing Chemo.

They believe since each patient is given there own set of clippers to be kept on site and that they are swabbing them with alcohol swabs prior to use that they are meeting adequate standards.

Questions: Are they meeting standards for the provision of Foot care in a community setting.

The only documentation that I have been able to support my claim that they are not meeting standards is a podiatry document that states if the instrument "May penetrate intact tissue it should be sterile prior to use".

Any guidelines from other community services that you can point me to would be appreciated.

They are setting me up very nicely re: autoclave, podiatry chair etc with only a bit of head bashing with the nurses regarding turf war but my concern is that they wish me to upskill the RN's using non sterile instruments.

I'm going well with only 1 official reprimand within the first 3 wks

__________________
Colin Power
Master of Podiatry (Curtin Uni)
powerpodiatry@bigpond.com
www.taichifootdr.com

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what you are doing is filth breaks all the professional rules and regs but not for profit organisations are not regulated so do not have to follow the rules. single use instruments are just that singe use not single patient for the next 30 years. but its cheap so they can make lots of profit to pay their large directors salaries and bonuses. If they dont get u to do it they will get some other judas to sell his soul for a few pieces of silver. read your minimum standards of sterilisation im sure it does not condone using dirty contaminated instruments.anyway in these difficult times a job is a job bugger the morals.

__________________
drive it like you stole it

Hi Colin

In NSW to be able to cut nails the RN, EN or AIN have to complete a footcare course, usually one or two days and of course follow infection control regulations. In the nursing homes that I've looked after, they have complied with these rules too.

I would contact the nursing association and see what they say, but sounds like quite shoddy practice. Goodluck...
Cheers
Esher

Hi if they are setting you up with an autoclave why can't the nippers be sterilised & then the nurses can continue with basic footcare with a bit of extra supervision from you? They are professionally trained nurses - are we not talking about basic care that a patient would do for themselves if they could? You could set up some training - or maybe there is something already up & running that they could do?

Im not able to find any guidelines for Nurses with regards to general nail care, however it appears a very risky practise. Sterilised instruments provide an extra cover and to avoid/reduce risk of infection. If instrument purchase is the issue possible autoclave purchase or disposable instruments may be the way to go.

if in doubt possible use the ApodC guideline as a reference to determine best practise to use http://www.briggatemedical.com/pdfs/...on_Control.pdf

There are Australian Standards on office based sterilization.
All registered health professionals should be following them, including podiatrists and nurses. They should give you guidence on the reuse of instruments on the same patient. Also check out the processes nursing homes use for finger nails.

__________________
Stephen Tucker
Calvary Health Care

My location

Hi Colin
I did teach the basic foot care course in Sydney, about 10 years ago (I know I should be ashamed!!!).
It did stipulate then, that sterilization of instruements had to adhere to the Podiatry standard of code of practice with cleaning, sterilization and calibration!

EDUCATION, EDUCATION,EDUCATION!!!!
Gently- hard not to trend on toes, I KNOW!!!!!!
Good Luck

The NSW Nurses' Association
PO Box 40, Camperdown NSW 1450
Phone 1300 367 962
www.nswnurses.asn.au
Page 1
Guidelines on Provision of Basic Foot Care by Nurses
Re-endorsed by Annual Conference 2008
These guidelines should be read in copnjunction with the Australian Podiatry Association’s (NSW)
Guidelines for the Provision of basic foot care by providers other than registered podiatrists
Basic foot care is the routine care of normal skin and nails of the feet. It includes cleaning
of feet, cutting and filing of non-pathological toenails and application of moisturisers.
The provision of basic foot care is a normal activity of daily living, essential to the
maintenance of healthy, functioning feet. There will be occasions when individuals, due to
acquired illness or physical limitations, will be restricted in their ability to fulfil functions
normal to their daily life, including basic foot care. All nurses have a professional
responsibility when providing assistance with activities of daily living to include attention to
a person’s feet.
It is important that foot care services offered to the community meet both legislative and
other prescribed requirements to ensure a high standard of safe, quality care is delivered
to the public. The NSW Podiatrists Act 2003 (and Regulations) and the NSW Public
Health Act 1991, Section 10AH permit the provision of basic foot care by podiatrists,
nurses, podiatry assistants, specified health care workers, independent foot care
providers, beauticians and pedicurists.
All providers of basic foot care must ensure that they work within the scope of their
respective qualifications, training and experience.
There is a clear boundary between the provision of basic foot care and the practice of
podiatry. While podiatrists may offer basic foot care and podiatry services, nurses are
generally involved in the provision of basic foot care. Registered nurses, enrolled nurses
and assistants in nursing may provide basic foot care where they are employed by a
hospital, nursing home or community health centre and provide the care as part of their
normal duties in that employment. In accordance with Section 10AH of the NSW Public
Health Act 1991, only registered nurses may, in the course of providing a foot care
service, provide treatment to a person who has a medical condition causing inadequate
blood circulation to their feet or peripheral neuropathy affecting their feet.
Policies and protocols consistent with the NSW Podiatrists Act 2003 and Regulations
should be developed at the local level in consultation with podiatrists nominated by the
Australian Podiatry Association (NSW). These policies and protocols should be endorsed
in writing by the employing facility and address the normal nursing process of assessment,
planning, implementation and evaluation, as well as mechanisms for referral to a podiatrist
or a medical practitioner if any abnormalities are detected.
The NSW Nurses' Association
PO Box 40, Camperdown NSW 1450
Phone 1300 367 962
www.nswnurses.asn.au
Page 2
All care given should be appropriately documented. Basic foot care must also be provided
within the requirements of infection control practice and legislation. Regular in-service
education in basic foot care should be provided by the employing facility.

Well we are all on the same page and I have the management looking into procedures and protocols.

There is light at the end of the tunnel

__________________
Colin Power
Master of Podiatry (Curtin Uni)
powerpodiatry@bigpond.com
www.taichifootdr.com