Avoid Agony of DeFeet - Get Current with Foot Care IP&C Best Practices Nan Cleator National Practice Consultant, VON Canada Objectives Identify the challenges to providing foot care in LTC Identify how infections can be spread during foot care Learn about evidence-based strategies to reduce the spread of pathogens and resulting foot/nail infections Be informed about how to select an external foot care provider. CHICA 2011 Page 2 www.von.ca Organizational Responsibilities Provide education to support professional foot care practice: To meet standards of care To respond to changes in practice Ensure evidenced-based practice CHICA 2011 Page 3 www.von.ca 1
What Guides Foot Care Practice? National: PHAC foot care guideline Accreditation IP&C Standards Provincial: Regulatory Colleges Provincial Guidelines & Standards Organizational: Policies and Procedures CHICA 2011 Page 4 www.von.ca What are the Challenges to Providing Safe Foot Care in LTC facilities? CHICA 2011 Page 5 www.von.ca LTC Challenges: Vulnerable Population Advancing age Foot disorders Soft tissue, nail, bony and gait disorders High risk feet related to underlying diseases: Impaired circulation Impaired innervation Impaired biomechanical function Diabetes CHICA 2011 Page 6 www.von.ca 2
Feet as a host for infections Blood borne pathogens: Hep B & C, HIV Common foot infections: Fungal (athletes foot, fungal nails, yeast) Viruses (warts) Bacterial infections (MRSA, VRE, C.Diff) CHICA 2011 Page 7 www.von.ca LTC Challenges: Staffing Higher ratio of UCPs & R/LPNs versus RNs Foot care by RNs: expensive/ties them up UCPs and L/RPNs: limited scopes of practice Supervision CHICA 2011 Page 8 www.von.ca Challenges: Education Lack of internal expertise to educate staff: Foot care: basic/advanced Reprocessing Limited access to footcare/reprocessing courses to: To develop initial competency To maintaining ongoing competency CHICA 2011 Page 9 www.von.ca 3
How Are Infections Spread During Foot Care? Spread of Infection 1. Person to person 2. Improper use/management of equipment 3. Environmental contamination 4. Improper foot care technique CHICA 2011 Page 11 www.von.ca Person to Person Unclean hands Sharps injury to client or nurse blood borne pathogens PPE not using, incorrect choice, incorrect use CHICA 2011 Page 12 www.von.ca 4
Improper Use/Management of Equipment Re-usable Re-use of footcare tools on multiple clients without: Proper cleaning Proper sterilization Single Use Re-use of single use foot care tools: Emery boards Orange sticks Scalpel blades Pumice stones CHICA 2011 Page 13 www.von.ca Environmental Contamination Not routinely cleaning the environment: Foot/nail debris: nail cuttings, nail/skin dust on environmental surfaces Blood and body fluid contamination Nail dust: Use of rotary drills contaminates air resulting in potential nail dust inhalation (fungal lung infections) CHICA 2011 Page 14 www.von.ca Improper Foot Care Technique Nurse performing footcare beyond scope/competency Improper use/operation of foot care tools Working on unclean feet CHICA 2011 Page 15 www.von.ca 5
Summary of How Infections are Spread: Unclean hands Sharps Injuries to client or nurse Incorrect selection/use of PPE Improper use/ management of equipment Environmental contamination Improper technique (sharp injuries) CHICA 2011 Page 16 www.von.ca How to Protect? How to Protect Nursing Competency Routine Practices: Screening Hand Hygiene Personal Protective Equipment (PPE) Environmental Cleaning Proper Equipment Management CHICA 2011 Page 18 www.von.ca 6
Competent Nurses Ask about: Category of Nurse: RN and or L/RPN Employing organization: foot care & IP&C policies/procedures Initial competency: basic/advanced foot care courses Ongoing competency: Nursing accountabilities Employer accountabilities CHICA 2011 Page 19 www.von.ca Screening Ask about: Client screening practices to identify known/suspected foot infections CHICA 2011 Page 20 www.von.ca Hand Hygiene Ask about hand hygiene practices: What: Soap and water - visibly soiled hands ABHR When: 4 moments for hand hygiene CHICA 2011 Page 21 www.von.ca 7
Personal Protective Equipment Ask about PPE practices (selection and use): Gloves Gown Masks (surgical & N-95) Eye protection CHICA 2011 Page 22 www.von.ca Environmental Cleaning Ask about environmental cleaning practices: Between clients: Use of removable barriers during foot care (e.g. footstool) Cleaning/disinfecting chairs/foot stools Following foot care: Intermediate level disinfectant Damp mopping/dusting/hepa exhaust filters on vacuums PPE during cleaning Safe clinic space CHICA 2011 Page 23 www.von.ca Proper Equipment Management CHICA 2011 Page 24 www.von.ca 8
Proper Equipment Management: Single Use Ask about practices regarding single-use equipment: Linens, towels, and lotions Emery boards, orange sticks, pumice stones Scalpel blades CHICA 2011 Page 25 www.von.ca Re-Usable Medical Equipment: Cleaning Re-Usable equipment must be cleaned, scrubbed, rinsed & dried for effective disinfection & sterilization Ask about cleaning practices: Detergent Mechanical action Rinsing Drying CHICA 2011 Page 26 www.von.ca Re-Usable Medical Equipment: Non Critical Device Classification: non critical (touches intact skin) Equipment: foot care basins Ask about disinfection methods: Clean basins with detergent, scrub, rinse & dry Use of low level disinfectant CHICA 2011 Page 27 www.von.ca 9
Re-Usable Medical Equipment Critical Device Classification: Critical Why? Sharp/abrasive instruments have potential to enter sterile tissue (cuts, scrapes, nicks) during foot care Ask about sterilization methods: chemical or autoclave** CHICA 2011 Page 28 www.von.ca Critical Instruments & Autoclave sterilization Super heated steam, high pressure - kills all organisms Ask about: Organizational policy & procedure regarding autoclaves Competency of operators Maintenance Packaging Monitoring - mechanical, biological & chemical Records CHICA 2011 Page 29 www.von.ca Sample Autoclave Learning Plan CHICA 2011 Page 30 www.von.ca 10
Sample Autoclave Log CHICA 2011 Page 31 www.von.ca Rotary tools (e.g. Dremel drills) Risks: Dust inhalation Environmental contamination Client burns Ask about safety precautions: Do not use on known/suspected fungal infections Do not use in clinic settings Nurse wears a fit tested N-95 respirator to filter small dust particles Limit time drill is used Use other nail reduction methods Avoid use of fans CHICA 2011 Page 32 www.von.ca What you can do to support safe foot care? Provide a safe clinic space Assign environmental cleaning Follow safe practices for environmental cleaning Share information about known foot infections Reschedule clinics during outbreaks Reschedule resident appointments when illness CHICA 2011 Page 33 www.von.ca 11
Choosing & using externally contracted foot care services 1. Clearly define the role of the external contractor 2. Verify the quality of the services: Category of nurses Initial & ongoing competency Screening Hand Hygiene PPE use Sharps disposal Environmental cleaning Use of rotary powered tools Single-use equipment Re-usable equipment: methods of cleaning, disinfection & sterilization Autoclaves use: operator competency, monitoring, maintenance & documentation CHICA 2011 Page 34 www.von.ca For questions contact: Nan Cleator National Practice Consultant VON Canada nan.cleator@von.ca CHICA 2011 Page 35 www.von.ca 12