Disposable instruments

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hi, how many people in private practice are using disposable instruments? I am thinking about changing to single use instruments and I just wondered how people have found this. Have you passed any of the cost on to your patients directly?
I don't work from a clinic, i do all home visits and therefore think it will be so much more practical than having to buy a new large autoclave (which I will need to do before dec 2010 anyway) and find somewhere to use it at home etc.
Any thoughts would be appreciated.

 

Hi Michelle

I don't work in private practice, but we have had single use instruments in the NHS dept I work for since abut February. I would advise you to request samples from each of the companies/suppliers and choose the make you use very carefully. Some are quite a different quality to others. We have had quite a few issues with RSI since their introductoin, which seems to have now resolved with a change in make. It took a number of trials to get there though! Look out particularly for the sharpness of nipper blade, quality of hinges and whether the blades actually meet, as this can vary hugely. Also, don't forget the increased amounts of sharps disposal you will produce. Good luck :drinks

 

Hi michelle, i have some private practice but ont use disposable instument due to the cost and sharps disposal. However i have used them working for the trust and found them great. We used the packs from baileys instuments after previously using A.N Other company and found them to cause some pain for the pods hands and sickness leave. I would get in touch with a few companies and ask for a sample pack if you go down this route, personally i prefered the Baileys, the nippers were great, too good to throw away really and not very enviromentally friendly, i think they are around £4.50 per pack but also they produce a nail cutting pack, without the scalple handle. Best wishes, Jo .

 

Why would you need to buy a new large autoclave before Dec 2010?

GB

 

what I should really have said was a new autoclave that reaches a higher temp than the one I've got, as mine won't meet minimum standards after dec 2010.

 

Michelle

This doesn't mean you have to buy a large autoclave.

There are plenty of secondhand small bench top autoclaves for sale up and down the country as NHS transfer over to single use. For a small practice surely this is more economical than the purchase and disposal of single use instruments?

GB

 

you could be right. I feel like I'm going round in circles. More research needed I think.

 

Are the standards changing? i have a prestige omega 2, a little one in comparison and get it serviced every 6 months. It generally reaches 136 degrees for at least 3 mins... i wasn't aware things were changing... can you shed some light for me? You can pick one up on e bay by the way. I see little sisters go for around £500 - 600 pounds which is a bargain i would say... its a tough decision, best wishes, Jo

 

hi distalphalanx, from what I understand your's will be fine. But the autoclave I have only reaches 126 degrees but for about 12 mins. This is still acceptable for now, but from end 2010 minimum standards to be 134degrees.
I think I will look into autoclaves a bit more before I make a decision.

Do you have a way of tracing your instruments to your patients? Or is this only done in the NHS? I probably sound like I know nothing, but I've been on maternity leave off and on for the past few years and am looking to build my business up again, so looking for advice. Thanks.

 

Hi Michelle, i dont have any way of tracing my instuments, but i also work in 2 private pratices as an associate with pods that have been running their own practice for some time and they dont trace instuments either. Just to add that i am very particular about cleaning, i generally follow the SCP guidlines, wash them with an autoclavable brush in a seperate bowl, ultrasonic cleaner and autoclavable instument boxes which i also soak overnigh in a milton type solution just in case. I also have a little bead steriliser which is good for quick foot to foot use in the case of OM nails, its great and takes seconds. I think it's just common sense good practice but yes i do know that an autoclave should reach 134 degrees for at least 3 mins, SCP guidlines.. Best wishes on your return back to work, Joanna.

 

Little Bead steriliser???? What's that?
I could dry heat in an oven for higher and longer.
Autoclavable instrument boxes>?? Haven't seen any in Oz. Where do you get them? Carole

 

Stick with SCP guidelines and you should be fine. Bead sterilisers don't work!

As for the 2010 date, you may be referring to HTM 2010 (HTM = Health Technical Memorandum), where 2010 is NOT a date, just the number of the document! Quite a few people seem to have read this as the date.

 

Michelle
It is environmentally, economically and ergonomically unsound to use disposable instruments. Why would you want to change? In PP you have a choice- please do your research before you make the decision. In my books ,why would you fix something that aint broke?

Cornmerchant

 

the 2010 thing I mentioned IS from SCP stating that autoclaves that reach 126 degrees will no longer be acceptable from 31st december 2010, and that is what my autoclave at present does. Anyway, after a lot of research I am getting a new vacuum autoclave with printer and I am happy with that.
Thankyou to everbody who replied to my post, it has all been helpful!

 

Hello Michelle,

Hope you are okay. Just found your message on this arena and thought to get back to you.
Basically we manufacture the podiatry instruments (single use and reusable) in high quality on very competitive price.
Rather buying it from Bailey or any other company, let us just show you the samples and if you like the price and samples, we will go further. As everybody is price sensitive in Uk market nowadays, so if you prefer to buy direct from the manufacturers who supply to baileys and other, that will reduce your cost. Luckily, we are one of those suppliers.
So look forward to hear from you and may be we can meet up for that.
Thanks for your time and Good Luck

 

Hi Michelle,

I'm late to this disussion I know - but only just seen it. I use disposable instruments in one of the clinics I work in and this is why...

This particular clinic I am referring to is a Physiotherapy clinic and the caseload there is primarily musculoskeletal. They had no Podiatry service in place so it needed to be set up/built from scratch. It soon became apparent that now and then a more routine patient would make an enquiry about basic 'chiropody' treatment, and being private practice they weren't going to get turned away by me. However asking this clinic to purchase an autoclave, instruments etc and then to ensure I/they were complying with sterilisation procedures/protocols etc was a massive ball ache for all involved, particularly as I'm only there one day a week and maybe see only 1-2 routine chiropody patients a month at the most.

So I made the call and we now keep single use instruments in stock which I can open and use as and when required. Yes, I pass the cost onto the patient. Yes, they are not quite as good quality. I wouldn't want to use them if I was seeing 15 patients a day for routine care thats for sure. But for me, in this current situation it was the best option.

Ian

 

Unfortunately, this doesn't necessarily mean the NHS Trust will be selling their autoclaves: our Trust was told they were not allowed to pass them on to anyone as the trust would still be responsible for them, should any accidents occur.

 

I'm glad someone else has this opinion, I was beginning to think it was just me. In these days of green, can it be reasonable to use disposable tools just when everyone else is looking at ways of finding way to make things reusable, recyclable and reducing waste, podiatry is going in the opposite direction????

Dave

 

I simply asked my local G/P surgery if I could have thier old autoclave when they changed over, they were more than happy as it saved having to dispose of it.

interesting how they gave me all the paper work and it hadn't had a service of ages and certainly thier was no record of day to day or even weekly readings in the books!!!

 

Disposable instruments are saving alot of money to potential buyers and by using disposables, there is a less risk involved as well.

We supply the single use as well as reusable podiatry instrument sets to reputable companies in Uk as well as to the NHS.

General set of podiatary comes with a Nipper, Scalpel handle, Blacks file and diamond deb.

If you have any inquiries, feel free to ask at info@candore.co.uk

Regards

 

I think the legislation you are referring to also requires autoclaves to have a printable/tracable record. I thought about this when i purchased my Btype autoclave, which sterilises to 136 for 4mins, and can take pouched or bare instruments, and print from a printer or onto a data stick - how ever, it is a model from China, "GETIDY" and can I find anyone to service it? No! so if anyone has any ideas regarding this I would really appreciate it! As for disposable instruments, I think they could have their place but I am worried about the cost etc.

 

Oh?

Do tell.

My NHS dept has been using disposables for over a year now. I see A HUGE increase in cost and a very significant increase in certain risks. I don't see a decrease in risk anywhere. What risk does it decrease exactly?

 

It decreases the risk of Litigation from infections caused by instruments not being sterilised by NHS staff properly. At Bournemouth Hospital Orthdontics dept, they outsourced the CSSD to somewhere else in the country because of exactly that problem

 

How much litigation is there in podiatry for cases of infection by instruments that havent been sterilised? Does anyone know?I suspect it is minimal.

As far as I can see, as long as instruments are sterilised and clean at the point of use, that is more than adequate for the type of work that we do. Obviously sterile technique comes in to play for nail surgery/wound debridement etc. All of us use sterile blades and this is the most likely time we will breach the integrity of the skin.
Why cant we use a little common sense these days instead og jumping thro hoops that are mostly unsubstantiated.?

As for disposables- they are economically, ergonomically and environmentally unfriendly!

Cornmerchant

 

You are most probably right, but the litigious world that we live in here definately here to stay . As for risks of cross infection in foot care...again you could be right, but then again, it is still the case that skin integrity can be breached with nippers (although one wouldnt wish to get known for their lack of skill in this department!).

However, I agree with you that disposables make no sense as a total substitute for cleaning and sterilising instruments

 

We do indeed live in a litigatious world. But lets examine both sides of the coin.

NHS departments operate in a world of strictly finite budgets. No one would argue that staffing is inadequate and that as such patients often have to wait longer between appointments than we as helath professionals would like.

Disposable instruments cost around £4 per pack (being generous). 3 patients an hour, thats an extra cost of £12 per hour per pod.

The cost to employ a pod is what, around £20 an hour? Ish?

Say a patient is seen every 8 weeks. Add the cost of disposables and divide by the number you first thought of, that patient will end up being seen every 12 weeks. Or more likely discharged altogether.

Or stick with what has seemed perfectly adequate for the last X years, and there is no reason to think that problems with benchtop autoclaves are rampant, save £12 per hour and use that money to see the patient in 2/3rds the time you otherwise could have.

Which represents the bigger risk, economising by spending money which could be spent on more pods to see people more often on disposable instruments? Or economising on patient contact times to eliminate a POTENTIAL risk that a regularly tested autoclave stops working between tests at the same time as the onboard diagnostic equipment fails to TELL you that its not working.

Benchtop sterilization works. Its worked for years, it still works now.

And lets face it, those nippers cease to be sterile when they come out the pack and cease to be even clean after the first toenail!

As cornmerchant very rightly says

 

Slightly off thread here but, does anyone know of older pods still using the cold sterilization technique- instruments kept in a solution of disinfectant and used over again on the following patient?

 

Yes, I also know one who puts them in the oven !

CF

 

Heat sterilization at 140C for 1 hour in a good oven. Or in a pressure cooker, I am told this is widely used in Brazil, and probly other 3rd world countries moving up in ranking. In Oz, I know an oven user.
Let me scare you as a former dental nurse and now half way thru the pod course. I took a manicure and pedicure course in a TAFE (vocational trade skill school) last semester, the beauticians sterilized NOTHING! They 'sanitized' with disinfectant, with alcohol...dip and wipe. The criteria for 'cold sanitizing' is 15 minutes in the solution. They were not too bad with disposables. But they used nail nippers, black's files (called ingrowing nail files) and tweezers without so much as a dip. There was one sterilizer, we were shown how to use it, but discouraged from using it. I got to be quite an enforcer. A second was acquired while I was there, but never used. So, I am one the side of bench top sterilizers, or even the oven cook over disposable instruments. Fear of litigation is fine, but we all have compulsory insurance. I now have beauticians' insurance. $219.00 . Covers me for 10 million.
as a kid, 30 years ago, all dentists boiled their instruments, and some did have cold sterilization too, I encountered one who 'sterilized' his instruments in mouthwash tablets.!!

 

i cold sterilise pad files as they warp in the autoclave...what do others do...

 

May I ask what one of those is please?

Regards,

Mandy.

 

a foot file, such as Lispro foot sander?

 

Hi once again,

I sell something similar in my clinic.

Although for individual patient use.

The only foot dresser I would use on a patient would be a sterilised diamond deb file.

Regards, Mandy.

 

Do you get them to bring in their own file or do you not file rough skin? A diamond deb is not really substantial enough for smoothing larger areas, is it?

 

I do not expect patients to provide their own instruments for treatment. I do use a Moores disc (single use) if required. However, I find that appropriate scalpel debridement is sufficient to reduce symptomatic/problematic areas. I also always follow with advice RE: appropriate self treatment if required to prevent chronic problems occurring.

Regards,

Mandy.

 

So its not altogether outlawed in GB then?
I have been given the opportunity to start work in a very busy little practice, but the owner still uses cold sterilization which did worry me slightly. They were trained the 'old fashioned way' and still insists on practicing so. One set of instruments soaked in Chlorohex/ Meth' spirit. The same mandril's for all patients but the blades and gloves do get changed for every patient. The pod in question is very competent in their operating technique, bloody fast and has a client list to die for. Many of the patients have been to other pods for what ever reason i.e this pod has been on holiday, but they all come back to this one full of praises.
Im just worried about the legality of the sterilization technique as I cant find anything on the tinterweb explaining it in full.
I dont want to pass up this opportunity as I have been completely skint since qualifying just over a year ago, not to mention the skills I feel I have lost. Obviously I will employ certain techniques that bring my practices in line with current guidelines but if anyone knows of any recent literature on the subject of cold sterilization Id be grateful.

Ps Mandy its a foot dresser

 

Hi Shelley,

Your professional insurance provider will provide you with the sterilisation requirements. I would be amazed if they include 'cold sterilisation'.

I would be interested to know the outcome.

Kind regards,

Mandy.

 

The guidelines i have been given by my association is that whilst cold sterilisation is not illegal, the practitioner should be aware of "best practice" - which is to autoclave to 134 degrees for a minimum of 3 mins (naturally observing same protocols for cleaning and decontaminating instruments first), using an autoclave which will also record cycle data.

By the way, thanks for the info Mandy

 

...I would suggest you look at your membership body's guidance for more clarity though