Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Clinically clean or sterile

Discussion in 'General Issues and Discussion Forum' started by yannialice, Feb 10, 2013.

  1. yannialice

    yannialice Welcome New Poster

    Members do not see these Ads. Sign Up.
    I have just started with the nhs, having gone over from private practice.
    I saw a couple of instrument packs that has been opened by a footcare assistant that were sitting on the side. I asked her why they were there and she said she had opened them by accident and they would be used at a later date by another practitioner. I was quite surprised by this and said i would just put them in the dirty box as they were no longer sterile.
    I have since had a row from the manager saying that this is standard and even though they were no longer sterile they were clinically clean and that it cost too much and this was standard practice with in the dept.
    I am quite confused by this because if that is the case, then what is the point in using sterile packs and how can 'clinically clean' let you know how clean something actually is?
    any advice on this would be great as I am quite confused:confused:
  2. David Smith

    David Smith Well-Known Member

    I would say its not good practice but in reality when you open a set of tools to start a treatment then you are immediately in the same situation as above i.e. strictly speaking you instruments are not sterile any more. I suppose it depends what you mean by a later date, I doubt they meant the next day did they!? Probably they meant the next patient coming in within a few minutes. I probably wouldnt accept those tools tho if I wasn't certain of where they had been.

  3. In an operating room situation, which is a clean enviroment with sterlized instruments, the instrument packs are opened up and laid on a back table, exposing the instruments to the air in the room that probably has a few bacteria floating around the room from various sources. Even though some of these "sterile" instruments may never have been used during the surgery, or touched by unsterile hands/instruments, they will still be resterilized for the next case. This is the medical standard for operating room procedure here in the States.

    If you want to be the safest for the patient, then once the pack has been exposed to air by opening the pack, it should be resterilized before it is next used. However, if nail trimmers are sterilized in a pack, opened up mistakenly and then resealed a few minutes later, and then used to cut fungal toenails or some other procedure that doesn't go below the skin surface, I highly doubt any harm could come to the patient from this type of practice of instrument handling. However, I wouldn't want an instrument pack that had been opened for 24 hours to be used on any surgery under the skin since the infection risk would likely be seriously increased.

    You must remember, that as soon as a sterile instrument pack is opened to air, it is no longer absolutely "sterile". However, that would mean that all surgeries being performed in today's world of modern medicine are not absolutely "sterile" since there are probably a few bacteria that may contamainate instruments from the air they are exposed to while sitting on the back table of the operating room. In actuality, it all comes down to more about how much "acceptable non-sterility" you are willing to tolerate. Of course, this will be determined, largely, by the practice standards of your medical community.

    Hope this helps.:drinks
  4. LuckyLisfranc

    LuckyLisfranc Well-Known Member


    What is the accepted standard of care for US podiatrists when they perform 'routine' non-invasive podiatry interventions (ie callus debridement, corn enucleation and basic nail care) in an office or outpatient setting?

    Do most podiatrists use sterilised but not sterile instruments, autoclaved and packaged instruments per patient, or completely unsterile instruments?

    My observations are that for non-surgical, non-invasive basic foot care, the Commonwealth countries (UK, Aus, NZ) appear to have rather draconian sterility requirements that attempt to mimick operating room conditions - which I fail to understand or agree with.

  5. Lucky:

    There was a discussion on PM News on this same topic a year or so ago. From what I remember from that discussion, most US podiatrists seemed to think that autoclaving even nail clippers should be the standard of care, versus putting nail clippers in an "antiseptic bath" since the public expects "sterility" in doctors' offices, even though this practice doesn't make a lot of sense from a microbiological risk standpoint.

    It must always be rememberd that what matters most, medical-legally, is what is accepted as the "standard of care", not what makes the most common sense. Therefore, when you are sitting in front of the judge and jury for your malpractice case where one of your patients claims that your "unsterilized instruments" are what gave them their "life-threatening, sex-life killing, mentally depressing" fungal toenail infection..... that is when you definitely will wish you had been sterilizing all your instruments.;)
  6. Lab Guy

    Lab Guy Well-Known Member

    LOL Kevin!

  7. Rob Kidd

    Rob Kidd Well-Known Member

    Kevin is entirely correct. However, no one has picked up the critical issue. Sterile at point of use is a joke - it simply does not exist. But, sterilised since last use is the critical issue, but this seems to be difficult to gain acceptance for. As a non practicing pod, I really do not have an opinion on these issues. but the key messages do not go away.
  8. blinda

    blinda MVP


    Can I quote and reference you on this, in my advertising material for anti-fungals?

  9. Back in the good ole days of bench top, the rule was 3 hours. I'd say that's a fair test for an opened instrument pack. A chiropody clinic can be a fairly dirty place with flying toenails, aerosol nail dust and coughing patients. I'd not fancy them after this time.

    Unless they were still paper wrapped,
  10. twirly

    twirly Well-Known Member

    I would suggest you request the manager put this consent to use these opened packs in writing. 'Standard practice' may differ quite dramatically from written protocols. Either those recommended by the company who provides the sterile packs or the NHS dept. you currently work for. In the event of any consequential complaint you need to ensure you have any evidence required to support you.

    It is my understanding (I could be misinformed), NHS moved to pre-packed instruments to reduce the risk of infection. The managers remark implies they are just paying lip service to the change.

    It is a sad fact that common sense is often disregarded. What was standard practice in the days of bench top sterilisation have sadly passed.

    All the very best, Mandy.
  11. Ros Kidd

    Ros Kidd Active Member

    For many years I made a point of opening the instrument pack in front of the patient, I personally, as a patient, am very keen to see this same practice from my GP, dentist etc.
    We live in a world of MRSA and MRSA15, VRSA and god knows how many other resistances. No patient can therefore be considered basic or routine and I'm afraid to say that for the sake of a few bob/cents the manager was incorrect. Kevin is quite right patients will invoke litigation at the drop of a hat.
  12. phil

    phil Active Member

    I fail to understand as well. Non invasive foot care is non invasive. I believe that cross contamination is important to prevent. But if a pair of clippers has been sterilised and perhaps opened and not used immediately, life or limb is not under threat.

    I have been known to sterilise a few burrs in a pack and pull them out as I need them throughout the day. Shock, horror. Technically, the moment the pack is opened it is exposed and no longer sterile. But, it's clean and not going to cross contaminate. And, it's more sterile than the toe it's going to immediately come into contact with!
  13. Tree Harris

    Tree Harris Active Member

    This topic is well covered, but I would like to add.......

    Above all else, always think it through. Are the instruments compromised aside from an open packet? Are they balancing on the edge of a cesspit? What is the level of contamination (if any) and is it significant?
    People/ practitioners can get caught up in the absolute nitty gritty and not see the forest for the trees.
    That aside, I like closed packets myself.
  14. Leah Claydon

    Leah Claydon Active Member

    My autoclave recently had its annual PAT test and calibration inspection and the engineer told me a tale of one of his clients that has some relevance to this thread.

    A lady podiatrist was taken to the Old Bailey by a patient who claimed she had contracted an infection after visiting her practice. The Judge asked the podiatrist how she could be sure that the instruments were sterile. She replied that she clipped the printout from the autoclave into her appointment diary so that she could trace her instruments to that particular date. The judge said that he could not see what more she could have done and dismissed the case.

    I keep a separate autoclave cycle diary, my staff staple the relevant printout into the diary page that corresponds to date the instruments were sterilized. My instruments sets are sterilized in pouches, so when taken out of the autoclave the packets are then stamped with the corresponding cycle number (self inking rubber stamp). On using the insturments I then record the cycle number in the medical notes. I can therefore trace every instrument back to the exact cycle. It's a bit of a faff, but probably worth it.

Share This Page