Industry Spotlight: Podiatry

Podiatric physicians provide important services to patients every day, diagnosing and treating conditions affecting the foot, ankle and related structures of the leg. As a health-care provider, podiatric physicians must make infection prevention a priority in their clinics. The CDC, the HICPAC, and APMA have published guidelines that address standard precautions for podiatrists, which are summarized below.

Disclaimer: Regulations on this page are provided for educational purposes only. Contact your state department of heath for current regulations.

 

 

Should I really be concerned about infection control?

Yes! There have been several documented cases of serious infections in podiatric facilities related to improper infection control. Some notable cases include:

  • 6 Proteus mirabilis infections caused by contaminated bone drills

  • 13 methicillin-resistant Staphylococcus aureus infections due to tools used for injections between January 1 and May 15, 1988

  • 10 Mycobacterium abscessus infections related to a jet injector used to administer lidocaine discovered by Florida’s Department of Health

What needs to be sterilized?

Critical instruments. Any instruments that enter sterile tissue or the vascular system (ie any object used in a surgical procedure. These must be sterile because any contamination could transmit disease. Critical instruments require high-level disinfection. This is the complete elimination of all microorganisms on an instrument, and is typically achieved by using a steam sterilizer. Any reusable medical instruments that are used to break intact skin (eg, nippers, forceps, splitters, and curettes) should be sterilized using steam rather than using chemical disinfectants. The CDC recommends that you test your sterilizer at least weekly, to verify that it is sterilizing properly. Visit www.WoodhouseLabs.com for more information.


Semi-critical instruments. Any tool that comes into contact with non-intact skin, such as tissue nippers or curettes used for debridement of an ulceration or incision, and drainage of an abscess. These devices also require high-level disinfection.

Non-critical instruments. Any tool that comes into contact with intact skin or nails. Since transmission of a disease is unlikely through intact skin, low-level disinfection is allowed. However, intermediate level disinfection is still recommended. Intermediate level disinfection destroys all vegetative bacteria, viruses and fungi but not bacterial spores. This is typically achieved by using iodophor, alcohol or chlorine.


References:
  1. TOTH BL: Methicillin Resistant Staphylococcus aureus Outbreak Associated With Injections at a Podiatry Clinic, Bureau of Epidemiology, Florida Department of Health, Tallahassee, 2002. 9.
  2. WENGER JD, SPIKA JS, SMITHWICK RW, ET AL: Outbreak of Mycobacterium chelonae infection associated with use of jet injectors. JAMA 264: 373, 1990.
  3. RUTALA WA, WEBER DJ, THOMANN CA: Outbreak of wound infections following outpatient podiatric surgery due to contaminated bone drills. Foot Ankle 7: 350, 1987