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Nail Drills and Burrs: CSSD

Discussion in 'General Issues and Discussion Forum' started by M Staines, Feb 20, 2009.

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  1. M Staines

    M Staines Member


    Members do not see these Ads. Sign Up.
    We are a County-wide N.H.S Podiatry Service.

    In the past month or so, we have gone over to C.S.S.D. instruments (from Bench top Autoclaves).

    The instrument sets that have been supplied, have no Burrs and one of the four quadrants that make our Service, do not use nail drills or Burrs. The other 3/4 presently do.

    We have a meeting arranged with the risk management team next week, to debate whether we should be using drills and burrs. We are currently gathering information for that meeting.

    The principle NO vote is based on the Safety issues (mainly to the Podiatrist i.e. lung disease etc).

    The Yes vote is also based on risk (to the patients) and consensus opinion.

    MY QUESTIONS ARE:

    1) Do the Schools of Podiatry still use and train people to use nail drills?
    2) Do you work in a similar situation and still use drills?
    3) Is anyone aware of good studies that show nail drills are dangerous/risky?
    4) Does S.O.C.A.P. offer advice?
    5) What is the situation overseas?
    6) Do your CSSD instrument kits include burrs


    Any other helpful comments/links would be gratefully received.


    Many thanks in anticipation of your replies.


    Tripod
     
  2. Nikki

    Nikki Active Member

    I work in a county wide trust too. We are in the process of going over to CSSD. ALL our sets will have nail burrs in.

    We recommend that all staff use appropriate PPE including masks when drilling nails.
    The main reason for keeping burrs in the sets is to prevent subungual ulceration by thinning gryphotic or chauxic nails. Patient comfort must also be considered as well as speed of treatment. Few pods (if any) these days are trained to reduce nails using a scalpel and file, rather the students we see are all familiar with drill use.
     
  3. G Flanagan

    G Flanagan Active Member

    I know we still teach students at Salford use of the nail drill.

    I work in Pod Surg, so i'm afraid i can't give you any more answers e.g community CSSD
     
  4. Atlas

    Atlas Well-Known Member

    This is a bit like smoking in the middle part of last century. Common-sense suggests the effects are harmful to us.



    I had a real problem with a clinic tutor insisting that it be used in the clinical setting etc.

    It needs to be taught and learnt; so I think one best-practice vacuum ventilation system needs to be available for use at universities where this can be done.


    The podiatry profession have been great in terms of infection control and the need to do it well; we are all beneficiaries of that mindset. However, it is a bit hypocritical that it allows its members, especially students to be ordered around like school-children to drill. (I saw this more at external clinics rather than university)


    I have a water/metho spray drill bentlon that I use sparingly. I will still use a mask and goggles etc. Its pretty messy, and the machines haven't run perfectly.

    If I ever set a purpose built room up though, I would have an orthotic manufacturing vacuum externally and ducted internally. There are issues though about what to do with the filters, and the biological external escape. If this is an issue though, well nail/skin drilling in an internal environment should be and issue squared.
     
  5. M Staines

    M Staines Member

    Thanks for all your comments so far.

    Nikki, Was there a problem with the CSSD processing of Burrs. For some reason we're being told that our CSSD service cannot handle them?

    For general interest, I did an Ebay on Nail drills and burrs and has a 15 page hit of drills for sale.
    They're for the beauty industry and don't appear to have any extraction (didn't look too hard)


    PLEASE CONTINUE TO ADD COMMENTS


    Regards Tripod
     
  6. Nikki

    Nikki Active Member

    All instruments are ultrasonically cleaned prior to vacuum sterilisation. This removes all debris, I am reliably informed.
    What do they say the problem is? If your CSSD has a problem with the burrs do they not have a problem also with Diamon Deb files? I am intrigued.
     
  7. markjohconley

    markjohconley Well-Known Member

    Hi Nikki, I haven't used a burr for ~2 years.
    Surgical masks were designed to protect the patient (lying on the theatre table) from the air-droplet expiring surgeons / nurses leaning over them. They were never intended (from what I read years ago) to protect us from them.
    A pity re the latter quote. Litigation a go-go methinks in the years ahead.
    All the best, mark conley
     
  8. Leigh Shaw

    Leigh Shaw Active Member

    Hi all my packs have burrs in them and CSSD has no problem with them. They used to pack them separatly but I think that was more to do with them lossing them than anything else. I still use a drill on most of my patients in the hospital setting and am often told that the younger pods dont use them but also dont reduce the nails either?
    How ever I do recommend a good dust extracting type as during my training I got an inner ear infection that was attributed to the nail dust, so its not just the mouth and nose you need to concider. That was 25yrs+ though and havent had a problem since.
     
  9. Emma

    Emma Member

    Hi!!!
    I am currently working in Australia and we have CSSD and have burrs within the packs.....
    I think the main issue with them regarding CSSD is tracability - the stem of the iburr s too small for it to be clearly engraved with a pack number.
    You can get disposable burrs though.....182.25 including VAT for a box 100.
    I don't tend to use them very often but the risk of a subungual ulceration is too high not to have one especially with number of patients who have long term conditions.
    Emma
     
  10. markjohconley

    markjohconley Well-Known Member

    The risk of s/u ulceration keeps being mentioned. How 'bout clippers and scalpels.
    Not much chance of inhaling microscopic fungal-containing nail plate fragments. We are podiatrists, a slightly bewildered mark conley
     
  11. Nikki

    Nikki Active Member

    I appreciate what you are saying however use of dust extraction drills combined with good ventilation will minimise the risk of future problems, you will never completely remove it.


    I agree Mark but students are simply not taught how to do this. When it has been suggested to students that we have on placement that they might need to consider this as an adjunct to their practice their answer is generally 'but we don't touch toenails anymore'!!
     
  12. I have routinely been using burrs and discs for most clients. I wear mask and protective glasses, and most of my clients do expect this treatment in a private clinic.

    The burrs are put in enzyme cleaner, rinsed, then sterilised.
    Discs are disposable which means exactly that, I have been made aware of people that reuse these and much to my disgust, dust bags are emptied in to bins and also reused. Interesting to see how many people do not make orders for bags that do require them.

    Hopefully this is no longer the case and people are aware of sterilisation requirements with the accredited podiatrist program, to enhance and enocurage continuing education and professional development, ultimately reward for both parties.
     
  13. Wendy

    Wendy Active Member

    I use a drill occasionally with internal dust extractor however I also use a face mask with fine particle filter to minimise the dust inhaled. These are purchased from and industrial industry supplier and not a medical supplier which do not seem to supply masks with the same high filtration.
     
  14. cornmerchant

    cornmerchant Well-Known Member

    How much more environmentally unsound rubbish can we produce? Discs, nail burrs, bags of nail dust, face masks?.......

    I am with markjohnconley on this one. Good old nipper and scalpel. I have never used a drill since qualifying and have had no incidence of subungual ulceration other than in new patients presenting to me.

    Maybe we should teach students how to develop skills which were once upon a time basic requirements?

    Carleen- I think patients only expect it because they have become accustomed to it. I explain to my patients the negative issues of drilling and they are moire than happy to have a treatment without it. Only people who want a pedicure for cosmetic purposes choose to go elsewhere, thankfully!


    Cornmerchant
     
  15. There are a lot of variants here and I also think it is about choices, not everyone requires the same treatment and often I like the end result with use of the mechanical file, and I dont us for everyone.

    We rarely used one when I was training as it was always broken and quite dangerous but I am very happy with my well maintanined and effective machine.

    It could be like my old black mercury fillings my dentist is now replacing with white ones, besides the ill effects of mercury, our appearances are important and Health and Beauty are all important factors for Wellness.
     
  16. magda66

    magda66 Active Member

    could i ask who you purchase them from and the specificationplease wendy?i rarely drill but when i do i use goggles and the klinimask as i used them when training in southampton and thought they were adequate for single use?
     
  17. cornmerchant

    cornmerchant Well-Known Member


    Carleen

    I do not think any of my elderly patients are the least bit interested in Health and Beauty. They are more concerned with being comfortable and having mobility.

    I leave Health and Beauty to the pedicurists/ beauticians.

    Cornmerchant
     
  18. I run marathons with a 78 year old senior lad and we did Gold Coast marathon last year with a 80 year old chick. Hate to think of all those over 65 years passing me next weekend in Ironman.

    Yesterday armed with my hand files, BP handle and clippers I saw some of the most horrendous elongated nails in bedridden clients that had not been attended to for years. Hypersensitivity and pain were intense, before I even started.

    I have to look for a mobile mechanical file next, my back is killing me.
     
  19. Valerie

    Valerie Member

    I feel that wearing a mask is essential even when using a foot dresser to file nails. Nail dust can be inhaled just from simple filing. I am newly qualified but the more experienced I become the more I realise how important it is to protect the podiatrist!
     
  20. aafke51

    aafke51 Member

    Re: Nail Drills

    Is there any one out there who uses a Bentlong Podo Gold Vacuum drill? If so, is it a reliable drill?
     
  21. hamish dow

    hamish dow Active Member

    Been in practice for @30 years now and have used dust extractors and now only use wetspray drills, I would never go back to dust extractors, as for burrs I choose the ones that have specific purpose fot the job required to achieve optimal result and best finish. I am not sure a central sterilising facility would oblige. Fortunatly I am in PP. In all that time I have only had 8 days of sick leave. Not too convinced that there is a significant risk involved, but it would be greater if ones clinical practice was poor or ones general health is on the poor side. Then again I also consider the concept of duvet days and sickies as nothing more than theft.
     
  22. serinec123

    serinec123 Welcome New Poster

    I know this is an old post, but, I wonder where these students are from? The trust I work in, we seem to be glorified nail cutters?!?!
     
  23. demetriusnagy

    demetriusnagy Welcome New Poster

    If you live overseas and need to convert one of our 110 volt drills to 220 volts here is a link to a company that sells transformers to convert 110 volt units to 220 volt
     
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