Floor contamination?

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Every day patients come in sit down on one chair take their shoes and socks off and then walk over to the plinth and sit down. Some of the dermatological conditions patients present with are infectious. I wonder if these infectious agents are ever transmitted from one patient to another via the floor? Should the floor be cleaned after seeing a patient with say tinea? Would you slide around on the floor barefoot after a day at work?

 

Thek

In the clinic at our school, and in the community clinics I have had placements in, we place paper on the floor in front of the patients' chair, which is beside the plinths so the patients' bare feet should not have to contact the floor directly. Floors are decontaminated after each session, and plinths after each patient.

The Society of Chiropodists and Podiatrist recommend in their infection control protocol that; "Areas in regular use, but not normally contaminated, such as...the floor, should be cleaned and disinfected daily."

I suppose it comes down to your individual risk assessment, along with staying within the appropriate guidelines. If you are concerned by the risk of cross infection from the floor then you need to decide whether or not to decontaminate the floor between patients.

Hope this is helpful
Euan

 

...not to mention all those natural micro-floora! Hee hee. Yeah, I know, it was pretty poor.
When I was at uni, we always placed paper towel at the foot of the chair etc. Possible a slip hazard now, I guess.

 

Yeah good point, I just wonder if it should be cleaned between patients. Paper towel on the floor can be slippery even if your young.

 

There is no reason for a patient's feet to even touch the floor!

 

Johnpod you've got me. My dear ol' ladies with their umpteen layers of "ihaven'tgotacluewhattheydo's", how do they remove same without feet touching the floor?, mark c

 

I get my lovelys to sit in the chair or on the plinth straight away and I remove/ put back on shoes/socks etc. Its much quicker and cleaner, until you come across the one that forgot she was coming and is wearing tights/stockings, even better when they have them on under trousers!! Esher

 

Say what!?!

How the hell do you assess a foot, let alone gait, in weight-bearing position then?

Common sense, and reasonable hygiene standards have to dictate here.

LL

 

Totally agree about common sense and reasonable hygiene standards.

There is no good reason why a patient with an infectious dermatological condition should put their feet upon the floor. Generally, shoes/short stockings/socks can be removed/refitted in the chair. Tights can be removed and shoes slipped back on in changing area/toilet prior to walking to the chair. This raises the questions: do we disinfect the toilet floor after each individual person has used the facility? and did they stand on the floor in there in bare feet?

1. A patient with an infectious dermatological condition would be in your surgery for that reason - not to be weightbearing assessed

2. Paper towels on the floor is no solution - slip hazard - and they are absorbent/porous anyway and thus provide no barrier whatever

3. Patients could/should be instructed how to dress for an appointment.

4. Tights can be pulled forward and the toes removed with scissors. The foot of the tights can then be reflected onto the ankle - a no-fuss solution. If it costs them a pair of tights a patient will be instantly educated for future appointments.

Chairs and plinths should be disinfected after each individual (may be incontinent), and floors disinfected at the end of each session.

Patient debris - from infective dermatological patient or not - should not reach the floor with correct use of a debris tray. If debris does reach the floor or the tray is spilled, then of course floor disinfection should follow sweep-up.

Patients should not put bare feet upon the floor for protection of patients that will follow and protection of themselves. No patient with an infective dermatological condition would wish to be or should be exposed to potential further infection of their already compromised skin.

 

****** myself laughing. Are you doing this under local?

 

What about if said patient is a marathon runner and is suffering from MTSS syndrome and is attending your clinic for this reason and is not interested in you looking at the skin complaint because they are under the care of a consultant dermatologist? Should I levitate them during my assessment ????

I find something called "cleaning" to be useful, I know it's old fashioned and time consuming, but so is infection.

P.S. this thread reminded me of a line from one of the Hairy Bikers cookery shows http://www.hairybikers.com/ They were making Bakewell tart /pudding (http://www.hairybikers.com/hairybakers_recipe_bakewelltart.html), as Dave was sprinkling the flaked almonds on top of the tart he said: "oooh, it reminds me of a chiropodist's floor!" I wonder were he got this analogy from??? ****** myself for yonks.

 

Thanks Simon, it would certainly teach tight-wearers a lesson and would probably sort out their T. pedis too!

As for the question you pose, it might be sensible to let the Consultant Dermatologist complete his treatment - then we might look to the MTSS if it still posed a problem. If the patient is fit enough to run marathons then he/she would no doubt survive the wait. The wait might even solve the problem.

Call me old-fashioned, but I too like the idea of 'cleaning'. However, it would have caused a strike at one time in the hospitals if anyone other than a cleaner picked up a broom.

 

John, you aren't living in the real world on this one. When my patients make an appointment they don't usually say: "I've got a place in the London marathon (insert any race) but I'm having problems with shin-splints, the race is in x (usually not many) weeks, by the way I've also got an infectious skin condition." If I used your suggestion, you'd have me sending everyone home after I'd done the subjective (or more commonly objective because they are blissfully unaware) until they got rid of their verrucae/ athletes foot. Get real.

 

Patient walks in with muddy boots, your floors are clean and he/she walks through his own mess. What do you do?? Hand him a bucket and mop and a cloth to wipe his/her feet, or say that they have made a mess and it will take a few minutes to clean it up before treating them.

Have you ever seen a GP or a Chiropractor clean the floor between patients. I do know that the benches are cleaned and new paper towels are put in place.

Don Scott

 

I regret, Simon, that we think differently. The infection is a transmissible disease process whilst the shin-splints is a self-imposed, non-pathogenic condition that will usually resolve the moment the sufferer stops pushing themselves beyond common sense and their inate ability.

Get real? A different sort of reality - perhaps a different ethic?

 

Does anyone know of any studies on the normal microorganism found on clinic floors?

 

These papers relate to HPV infection and floors:

Adams BB (2000) Transmission of cutaneous infections in athletes -leader Br J Sports Med 34:413-414

Johnson IW (1995) Communal showers and the risk of plantar warts J Fam Pract40(2):36-8

Rigo MV et al 2003 [Risk factors linked to the transmission of papillomavirus in the school environment Alicante 1999] [-article in Spanish] Aten Primeria 2003 Apr 30;31(7):415-20

 

If you have carpet, then you're RS!

 

Hi all,

Not wishing to appear to be dense

What is RS?

Thanks muchly,

Mandy.

 

believe that'd be rat droppings if my understanding is right. RS that is

 

Thanks Icp,

Must admit the use of Australian clinical abbreviation (RS= Rat Droppings!) can be tad confusing to us Brits.

Cheers for the explanation,

Mandy.

 

This thread is rather chortle-some! Thank you all!

Am having a rather 'slow'day - took me a while to work out how 'S' could be short for 'droppings'. Nevermind, eh.

Back to the original subject of the thread; my patients are all 'high risk' and most need to be assessed weight-bearing/mobilising and, of course, unshod.
So there you go, yet another thing for me to worry about.

It's all too much

 

Hi Hannah,

I am fortunate that I have an Aunt in S.Australia. She explained the 'S' for droppings bit.

Otherwise I would have Googled it in latin!

 

Here I was thinking that this was a thread that I could contribute to- in regards to hygienne and all, but got distracted with the red herring about RS.
But thoroughly enjoyed the whole process.
Cheers
Tree

 

When we did microbiology way back 20 years ago, we went around taking samples off every known surface, the dishes came back a few days later loaded with many organisms, bacteria and fungi, fauna and flora.
Many of these surface had been cleaned several time after the contol sample was taken.
1 control - no washing
2 water
3 soap and water
4 Chorohexadine
5 Methylated Spirits
6 Bleach

We also did hand test
1 No washing
2 water
3 soap and water
4 Chorohexadine

The result showed that once water was added in the cleaning process that the number of organisms decreased.

That said HPV is unaffected by water as my patients still present to my practice with VP contracted at the local swimming pool. A lot could be said how viral particles migrate from surfaces to skin. My theory is that a swimmer leaves viral particles on the wall of the pool when they push off and when the next swimmer comes along the viral particles enter through the pores in the skin. Thus contamination has commenced.

Unless we an our patients walk through sheep dip like troughs every time we/they enter our rooms (This is to clean the soles of footwear only) we will not stop pathogen entering and then you have Louis the Fly.

Every time we rub our skin we create atmospheric contaminants. 60% + dust in our own home is us floating around. "Dust Bunnies"

Don Scott

 

This is one of the most ridiculous statements I have ever seen written by a foot-health clinician.

Skin is our protector against bacterial and other infections. I don't know what you are talking about here since all the surfaces of our skin have pathogens on them. If I have a patient that doesn't want to walk barefoot on my floor, then I consider them immediately to be on the weird side, having no understanding of how the skin of the human body works relative to the microflora that exist on nearly all surfaces that they contact throughout the day.

By the way, they do make this product called soap that can be used quite effectively in combination with tap water to clean the skin if the patient has a bacteria phobia about your floors. You should try suggesting its use on these phobic patients who are worried about contracting infections from walking barefoot on floors.

 

Certainly here in Britain there is a move to insist that vacuum autoclaves must replace displacement autoclaves because they do not adequately control prions. There is much debate about how instruments must be packaged and how audit trails can be created. Treatment chairs are supposed to be wiped down between every client. This is regarded by most as 'best clinical practice'.

In the light of this near hysteria, it seems rather unnecessary for a Podiatrist to be told by a DPM that we all have pathogens on our skin and that exposure to floor pathogens is not of any great concern.

In reality, I actually concur with Dr Kirby that our immune systems can cope with everyday exposure to common pathogens. I also feel that much of the new thinking surrounding preparation of instruments for non-invasive procedures upon what must be admitted are dirty skin surfaces (in the surgery sense, regardless of soap and water) is over-the-top to the point of being ridiculous.

What Dr Kirby's observation clearly demonstrates is that there is a great deal of nonsense around the area of disinfection/sterility.

However, my training has taught that we should not expose our clients to identifyable risk, such as exposure to environmental pathogens and fomites originating from previous clients.

Thek has stated that people with infectious conditions regularly walk across this particular clinic floor. In the light of the possible risk of cross-infection I repeat that it is encumbent upon a clinician not to put clients at risk of even theoretically possible cross-infection, particularly since the risk has been identified. The simplest way to reduce this risk is to keep the bare feet off the floor. It is simple to devise a technique by which this might be done.

We cannot know what will be presented until the feet are raised for examination. There is a possibility that we shall be presented with T pedis, HAV, open wounds weeping blood, serum or pus on the plantar surface. We are not all engaged in biomechanical work, and in a clinic dealing with general conditions - including infectious conditions, it constitutes acknowledged good practice to protect our patients and demonstrate care.

 

Of course all feet have normal flora. Quite often though patients will present with "foot pain" they will take there shoes off, walk over to the plinth and during examination it becomes obvious that they have a planter wart for example. From my understanding the papillomavirus is contagious if directly exposed to the epidermis. Couldn't this papillomavirus now on the floor infect another patient when they walk across the floor? This is just one example. Think of all the other infectious dermatological conditions? Of course there are ways to avoid this cross-infection from happening. I was wandering how others manage this issue? I think it may be best to have patients jump onto the plinth straight away. This way there feet don’t have to touch the ground. However what if a weight bearing examination is called for and the patient has an infectious dermatological condition?

 

I do surgery, treat infections, plantar warts, ingrown toenails in addition to having a very busy trauma/sports medicine/biomechanics practice. Patient have walked barefoot on my clinic floors for the last 23 years of practice. In the thousands of patients (approximately 5,000 patient visits per year currently) I have seen in that time, I have never had anyone accuse me of my clinic floors being the cause of any infection of any kind.

We have the janitors clean the floors every evening in the treatment rooms. If any patient have open wounds on their foot, they are not allowed to walk barefoot on my clinic floors. Unless your patients never let their feet touch the ground anywhere at any time, always wear sterilized non-breathable socks and shoegear all the time, and use a daily antibacterial scrub on their feet, they will have any number of pathogens on their feet. In fact, even with antibacterial scrubs, many spores may still be present on the skin so the feet can never be made completely sterile.

Luckily, I know of none of my patients who are so phobic to lead their lives trying to keep their feet sterile. And if they tell me they don't want to walk barefoot because of possible germs, I tell them that their feet are already "contaminated" even as we speak and that walking on a floor that is cleaned daily will not increase their risk of getting any infections, and certainly no more than walking in their home, their bathroom or shower while barefoot. The suggestion that patients would get more infections by walking on my clinic floor, to me, is ludicrous.

Do you also not shake hands with patients and not touch their skin with your hands because you worry about contaminating either yourself or your patient with each other's germs???

 

Of course you can never sterilize skin. I don't know if this is even an issue, that's why I created this thread But I thought that in theory there might be a cross-infection issue as some dermatoses are contagious. I guess if you have never had an issue then it's noting to worry about. Yes I do shake hands (but only with a glove on lol :wacko

 

I think podiatrists should definitely disinfect the floor after every infectious foot case - it's basic hygiene! This goes for the chairs and plinths, I'd say...

 

Do you disinfect your hands after shaking hands with your patient or when you touch a doorknob or a telephone? Why not?? It's basic hygiene!

 

Sarcasm gets you no where kevin... I shake hands with a patient with bare hands, and I examine them with gloves on, then wash my hands after seeing them. I'm talking within the realms of the podaitry treatment room.

 

Jay:

What is your definition of an infectious foot case? Does that mean that the patient has bacteria, fungus and human papilloma virus on their feet? If so, then you had better be disinfecting the floor after every patient. Maybe you should start heating the floor up to about 200 degrees to sterilize it after every patient, and then don't let anyone walk on the floor without sterile shoes, and also have a positive pressure seal on the door to keep atmospheric contamination out. It's basic hygiene!:bang:

 

Interestingly whilst I was a student at New College Durham, this question also crossed my mind as at the start of the 2nd year we were advised to refrain from putting paper down on the floor as there was a risk of slipping or tripping. This directive came from a lecturer attached to a primary health care trust and so was adopted within the training environment. Because of this I deceided to investigate the possibility of cross contamination via the floor where patients were asked to stand bare foot, and was the suject of my dissertation. The results indicated that there was very little evidence of fungal contamination, bacterial growth was found on all the samples taken, and viral could not be investigated due to the contraints of the study. The results showed only a slight reduction in contamination on the floor area which was wiped with chlorhexadine so this does not negate the risk. So without being able to steralise the area we cannot be sure to remove all contaminants. After all, we all walk around without shoes at some point and there will always be bacteria present.

 

I'm still worried about my clinic's carpet as the rooms are rented and the landlord would not contribute to vinyl flooring.

How do you disinfect carpet on a regular basis?

I have a plastic chairmat under my work area and the patient chair. Maybe I should get another one for where the patient disrobes their feet and maybe another where I do gait analysis and disinfect them all with chlorhexidine (how often? -between patients?, twice daily? -probably the latter) , but then there would be an increased tripping hazard!

As I said before, I'm R.S!:sinking:

Not that we have a rat infestation!

Cheers,

Brad:drinks

 

This thread has gone beyond the edge of sanity.

Ever since Lister started plunking surgical instruments, hands and gloves in phenol we have known that microorganisms play a part in infection. This point is beyond debate now.

Patients expect a basic level of hygiene whenever they present to a private clinic, hospital department or any medical environment.

Common bacterial, fungal and viral pathogens exist everywhere in the environment - from bathrooms, to the garden, shopping centres, schools - and health facilities. If humans were that prone to infectious disease we would be all rabid corpses by now.

Common sense prevails. If there is a draining wound - try not to let them walk around the treatment room without a dressing. If there are blood or body fluids that contact common surfaces, clean them up with anitbacterial solution.

For heavens sake - most of the time you wouldnt even know if someone had a subclinical skin infection anyway - ! All of my HIV+ and high risk patients would all be dropping off by now if a once per day mopping of the floors wasn't enough.

There are bigger things to worry about than this.

LL

 

LLF,


Whilst one doesn't want to go overboard:sinking:, I believe that a healthy discussion on basic hygeine of our clinic floors is helpful to many of us. Especially in this litigious society in which many of us practice!

P.S. Are you flaming me? (see thread on Level of Proof for Forums).

Cheers,

Brad:drinks

 

I have never understood why a clinician would HAVE to wash his hands immediately AFTER removing their gloves. Obviously if there was a likelihood of puncture during treatment then fair enough, but always (I can comprehend the importance of washing BEFORE donning gloves). Mark

 

Hi Brad
I understand the frustration of not being able to change the floor covering without the landlords help - I have a similar problem (shared by many I am sure) in that technically I should have 2 sinks in my clinic, 1 for hand washing and 1 for waste water out of my autoclave and ultrasonic cleaner. This is not possible so have had to work round the problem using a bucket and outside drain.......
Is there a possibility of your professional standards being used as proof for the landlord to help you? I appreciate the tripping hazard may be an issue but is there a larger sized mat that can be used for the patients with some type of fixing?
As to cleaning the carpet regularly cost out steam cleaning weekly re new floor covering - the new floor covering might be cheaper for the landlord (lateral thinking can sometimes help).
All the above are my own opinions and am just trying to help:morning: (yup just read the level of proof thread:drinks)
Wendy