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When using a dremel drill and sanding disc to reduce thick fungal toenails a fine dust coats every surface in my exam room. I have a vacumn attachment to my drill which captures some of it and I also have a room air filter on the floor that helps. I also wear a mask. I have always had an exam room vented to the outside but the current exam room is not. I need to get opinions on the standard of proctice regarding cleaning the air during nail debridement. I would be greatful for input about this.
Sharon J.

Hi Sharon,
Are you really using a dremel in a surgery situation?
I use one for dom visits, and an excellent piece of kit it is.
However in a clinical sit' I would suggest you invest in a good dust extraction drill.
I use a Seco drill, there are many on the market, non are perfect.
The alternative is water spray drills, arguments for and against.
I love my drill and appreciate the health risk I take using it.
I also ride horses.
What about hunting, does it resemble the HPC?

Hi Sharon!

I recently bought a Hadwe SB24 Dust Extraction drill, and I love it!
It has certainly cut the dust down in my surgery a lot.

I was using a Dremel previously, and still do for the home visits.

I'm interested in what is the best room air filter. At the moment I'm using one I bought from argos, Bionaire, its ok but sounds very loud and I can't hear my stereo above the noise, nevermind the patient, so I don't have it on all the time.

Is the filaire model as sold by smae (podiacare) any better I'm wondering?

Cheers,

Robin.

Sharon & Robin
It is unfortunate that whenever people raise their head above the parapet they get shot down.
From my position I have to say if your training encouraged you to use the Dremel rechargeable drill, did it fail to tell you it would fill your surgery with dust?
The fact you both are prepared to ask questions makes me give you the respect of a reply.
All I can suggest is you join an organisation which will give you better guidance on health and safety.
This is posted with genuine respect and not meant to be critical.
PS Try tungsten carbide bits they run cold do not abrade skin and produce big chunks (not dust) cost a bit more.

Hi Reg!

Thanks for the reply!

When I trained with the smae in 1988 I used a drill a couple of times. It wasn't a dust extraction one, it was just a mains powered podiatry drill. I can't remember what make...

I think (it was a long time ago mind) that I bought the Dremel from Footmans (as was). I moved into surgery work just over a year ago, and I bought the Hadawe in October last year. I now do 2 days a week in the surgery now, but want ultimately to give up as much domicillary as possible.

Your point about health and safety is a very good one. I admit I only learn't about Farmer's Lung etc and the perils of drills from an ex SRCh friend of mine a couple of years ago.

Which organisation are you suggesting I join?

The Society of Chiropodists & Podiatrists will offer me Associate membership. I'm not that excited about that. I would be interested in staying with the SMAE/BChA and registering with the Society so that I could fully access their website and all the info that their members get. I have seen the large manual scpod members have and I was VERY impressed. However, I don't need their insurance, I like Mike Batt and I like the fact that I'm HPC registered and I'm not too sure that the likes of me would be warmly welcomed into the ranks of the formerly SRCh, unless I was to re-qualify. (I think I'll start a thread about that...)

However, the SCPOD membership form doesn't give me the option of paying a nominal fee to just gain access to the above. As the SCPOD and many of it's members don't seem to 'value' my qualifications, what would I be other than a second class member? My sources tell me there are about 60 newly grandparented pods who have joined the society. It's not a lot is it?

I shall look into tungsten carbide drill bits.

I do appreciate your reply Reg. I'm being sincere in saying that.

Best wishes,

Robin.

Hi,

If you use good quality nippers, e.g. Mobilis S80's, then most of the fungal nail can be removed prior to drilling to finish/smoothing over. Much better than drilling from scratch! Occasionally I use a no.10 scalpel and/or tungden carbide shaver bur (available from Trycare).

Cheers,
Graeme.
:)

Hi Sharon and Robin

I agree with the other posters on the subject of tungsten burrs, they are:
1. Quicker
2. Produce less dust
3. Last longer
4. Do not "heat up" badly during use

Added to this I always wear a mask and use a dust extraction drill in which the dust bag is changed frequently. I have a dust extraction unit (with a HEPA filter) in the surgery which hums away quietly all day. When I first got the dust extrator unit I was surprised by the amount of dust in the filter at the end of each week (it is removed and cleaned on a weekly basis) -- formerly this dust would have circulated in the air and ended up on the surfaces and in the lungs of anyone in the surgery (a sobering thought). For an evidence based approach to the effects of nail dust on podiatrists take a look at Abramson and Wilton (1992).

With best regards, Poll.

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'There are no problems - only opportunities to be creative' :)

I use a Filtaire 300 in my clinic.

I don't know how effective it is because I've always used one. But what I would say is there is no more dust on the work surfaces than in my own home (which isn't saying much at the moment). It is extremely quiet, unobtrusive and almost maintenance-free. Some patients ask what it is, and I say it is a special filter which filters the air down to micron level, and they are quite impressed. I could go down the route of experimentation using agar plates, etc, but time is too precious.

I suppose the crunch would come if the filter broke; would I replace it? Only if there was a noticeable increase in dust in the atmosphere and work surfaces. I am hoping this will not happen for some time yet (sorry).

Regards,
Graeme.
:)

I am greatful to all of the people who responded to my question. I am a nurse practitioner in the U.S. and much of my training in the foot has been at specialized foot conferences, training programs (Carville), and one on one with Orthopedic and Podiatric surgeons. These educational sessions did not include practical directions on cleaning the exam room air. In my exam room I debulk the fungal nail as much as possible with clippers and then sand it smooth and flat with med/coarse sanding discs. I will investigate the drills, bits, and dust extraction methods suggested by the others posting replys to my original question.

Hi

I have an air-conditioning unit on the wall. It collected a lot of nail dust so I fitted it with a pollen filter. That gets clogged up in no time and costs an arm and a leg to replace. I saw a free standing one at the Ideal Home Exhibition with a roll of filter, where you could pull through a new piece of filter paper and tear off the old bit. About 200 GBP if I remember about two years ago.

Is there any point in wearing a mask while you debride a nail, if you then discard it and breath in the dust for the rest of the day!

Luke Hawkins

There are MUCH better portable-rechargeable alternatives to the dremel. I have a small battery operated drill that has forward and reverse modes, 20,000 rpm's, high or variable speed settings and that is actually designed for feet and not craft projects. It is much more professional and the comfort level for the client is beyond compare. I have not used a dremel in 3 years and think the only place for them is in a third world country, garage or garbage can. I can not believe it is still the "standard" equipment that both podiatrists and nurses are using for feet.

I discovered this new drill at a trade show for cosmetologists and was embarrared by the fact that pedicurists were using superior tools to medical professionals. Anyone using dremels needs to rethink!!! I have also discovered the wonderful world of bits. Am now using ruby carvers, diamond bits and tungston bits. I have about 15 varieties and can bring down the thickest nails and calluses in about 90 secs (yes, I timed it!) I am doing faster and better work than ever.

In my office I use an Ortho-fex Microair drill made in Holland with a built in vaccuum, but for thick nails I also have a Sani-Vac (stand up vac) and wear a mask of course. I am investigating getting a portable vac system that can be put into a rolling suitcase with holes cut out for the cords. I will definetly look into get a room filter.

Cheers!
Laura Roehrick RN
Santa Rosa, CA. USA

For every one producing dust from nails and skin there are long term issues re lung health. It is possible to buy fairly cheaply these days $200 Aus an appliance known as a HEPA filter which sits on a shelf in your tx room and filters air. I have had three brands...Sunbeam at the moment. You replace an internal filter unit every so often.
Most of the vacuum drills take in some of the dust and then spit all the fine stuff out the back end, as do most vacuum cleaners, get a HEPA vacuum cleaner too.

A HEPA filter will filter down to approx 0.3 of a micron....this is what counts, they are the aerosols that float around all day for you to breathe in. I have used them for years, recommended by the asthma foundation for asthmatics (one of my kids is).
Makes a big difference over a day when you are busy with the drill.
Regards Phill Carter

I have no direct connection with the foot trade but having just come across some discussion about dust extraction re. the use of hand grinders on nails, I offer the following suggestion:
having been involved in teaching Technology for many years and being responsible for monitoring health and safety in school, I have found (in the UK) the advice of Local Aurthority H & S advisors invaluable as has been the Health & Safety Executive. A call to either of these bodies should help resolve some of the queries re. dust extraction and permitted levels of exposure.
Rob

Hi Sharon, read all replies with interest ,I have been using dremel for 6yrs and am looking for a microdrill with dust extraction or the combination of vacuum plus water spray.would appreciate any suggestions on which is the most efficient and .I do more thick skin reductions than nails ( use a pedicurists mini drill @ 10000rpm for nails) the amount of skin dust generated is scary.

please give me some suggestions on the most efficient dust extraction systems you are using out there, pure vacuum extraction or the combination vacuum plus water spray or pure water spray found on podiatry mini drills.

Hi all,
Have had many probs over the years with drills and dust extraction One of the main objectives in our new practice was to provide a dust free environment. We have tried most of the dust extraction drills which work but arent 100% effective. We have also tried the water drills which again, work but arent 100% effective. They also cause an OH&S problem with water particles on the chairs and floor surfaces.I imagine te fungus just loves the addition of water to its environment aswell.We are currently working on a prototype which will eventually capture and filter most dust at the source. Combined with a dust extraction drill i think we have virtually achieved our objective. Now to overcome the 'noise' factor and 'patient perception' factor. Will keep you posted.

I am working with Diana and the group involved with the prototype of the dust collection and air filtration device. I am visiting the UK in May-June and spending a little time in the Central London and Brentwood, Essex areas.
It would be of interest to find out any needs in the UK, and if time permits to meet up with interested parties.
Regards Alan

Have you thought about cleaning your clinic or employing a cleaner?

You must only clean it every week or two to accumulate that much dust.

Great info thanks.


BTW I am not sure how to POST A NEW THREAD, so I will ask this here if you dont mind:

QUestion:

Does anyone have any link or info re: custom foot orthotics verses simple otc and remedial arch supports? Why?

Lately, more and more companies are hiring "physiotherapists" who purpose is to perform a simple biomechanical exam and thus determine IF an orthotic is warranted. What they do is first place a simple arch support from a store (spenco/Dr.Scholl's) or they make their own pre-moulded arch support and ask them to return in 2-4 weeks time. Their attitude is IF that person gets great relief, then orthotics are nOT warranted ( although the arch supports are simply cushionong the feet and supporting the arch versus biomechanically correcting the feet). Would you agree with this as ANYTHING in your shoe versus nothing would feel better, but what of the long term ramifications?

Their argument is that "their studies showed" 100% of their patients who would go to a podiatrist for foot or foot-related pain , would get an orthotic 100% of the time.

Any arguments here or support for this theory? Do I start to close down the "orthotic" portion of my practice and start telling everyone to go get Dr. Scholl's first??

Please help. Any advise that I could mull over to counter this theory would be helpful.

FootmanFootman

Dermot, we are not suggesting that general cleaning is not being done, but that it is important and trying to reduce the challege load is an advantage. If we can reduce the airborne contamination, and indeed bring it down to an acceptable level considered by other industries and professions, then we are working towards a community service.
The problem with asthma and associated problems seems to be on the increase for some reason or other. Indoor air quality in commercial buildings rears it ugly head from time to time. Many of us are not affected, but for those that are sensitive it can be a real problem.
We are working to improve the situation for clients and practitioners.
We look forward to your support.
Regards Alan

Hi all, I use a Podo vacuum drill from Germany, works amazingly well, what also works very well is an external wet and dry vacuum cleaner in an adjoining room with a specially adapted pipe that goes through the wall and attaches to your handpiece, any good engeneering company can make a pipe for you at a very cheep price. If you wish to know more about the Podo drill please contact me on merchen@netactive.co.za. Regards Mike Erchen Cape Town, South Africa

http://www.health.gov.on.ca/english/...c/bp_cds_2.pdf

http://www.phac-aspc.gc.ca/publicat/...3s8/fcb_e.html

Here are two infection control policy sites from Canada.

I just attended a foot care conference in Ontario Canada where a 3M expert talked for an hour on masks!! To make a long presentation (which was really great by the way) be sure you are using a N-95. Surgical masks offer you no protection. Be sure and be fit tested as well.

You might find them helpful. I use an orthofex with a vaccum at the tip, and add a stand up vaccuum called The Sani-Vac

http://www2.mooremedical.com/index.c...etail&PID=3705

Not sure where you would get a sani-vac outside the US, but you get the drift. You could probably make one.

Just to add my two cents, we have a wet drill at our clinic and personally I think it is awesome - try one :-)

Phil, a recent visit to my podiatrist for corn removal unearthed the fact that a group involved in the Victorian health system have been discussing air borne contamination recently.
Are any of those people involved with Podiatry Arena?
How would I make contact.
I am still working on the collection at source and filtration device that we have discussed in the past.
Regards Alan Mead

Hi Alan,
Since we spoke I have moved to Bairnsdale, rural practice at it's best...sunny Lakes Entrance and East Gippsland. You can now buy small hepa filter devices from Carbatec in Melb from as little as $300 or so, like a little Dalek, get a flexible hose that will stay where you put it and the job is half done...I have not bought one and tried to do it, but I have thought about it. My new phone if you want me 5152 5391. To find these others try the association or public health group via one of the bigger hospitals. I do still use a room filter though.
regards Phill Carter

Sorry about this,

This posting first came up as an alert.

In the UK (or at least my UK brain) Victorian means 1890-1910.

So Victorian infection control.

Sorry, no comment about the Rugby, not the game I played as a lad.

Still nice to see the 'Mother country' expressing her genes, even if it resembles football.

Just seen a response about cheap Hepa filters, got one did not work.

Best dust collector I have is the electrostatic effect of my fan, covered in dust.

I have owned and used a range of HEPA filters for air filtering and they have all worked. To Dermotfox? I think you have missed the entire point of this thread....as has most of the profession, which is why more has not been done about this stuff before.

Thanks for your continuing support Phil.
I must get back onto the podiatry dust collection unit, having spent the last 6 months on the nail desk vent.
This device is for the nail beauty industry and controls the methacrylate adhesive odour and the dust from the filing and drilling. It does a very good job, in fact almost too good on the fine dusts.
We gained recognition from being a finalist in the Victorian Worksafe Awards, as well as being on the ABC New Inventors Show.
The podiatry size unit is still undergtoing trials in Sydney and I have a Melbourne practice interested in assessing it.
Again I am looking at a size of unit that will definately do the job, rather than a small less effective unit. I know that you are happy that your small unit does a job, but I would like to collect as much at the source rather than rely on turning over the whole room air.
The nail desk vent seems to be the only one of its sort in the world (a similar US unit is now not produced), there does not seem to be much available for the podiatry industry.
Canadians seem to be the most interested in a healthy workplace.
Regards Alan

Hi Alan,
I do think yours will be much better than existing options....just filtering the room air helps but is a poor 2nd to picking it all up at the point of generation. I will be a keen customer as soon as I can get one.
regards
Phill Carter