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Patient held non sterile instruments

Discussion in 'General Issues and Discussion Forum' started by airamasor, Nov 22, 2010.

  1. airamasor

    airamasor Active Member

    Members do not see these Ads. Sign Up.
    In my local area the podiatry department in the NHS has merged with another area and they are now adopting this method. They use single use instruments, if they are not blood contaminated, they give it to the patient to take home, and then bring them back in the next visit.
    Is this legal? or ethical? What about the staff who does not agree with this, can they refuse to give instruments to patients? (I'm a private practitioner, glad that I'm not working for the NHS)

    Do anyone know what is the Society or HPC view on this matter?
  2. sam_wallwork

    sam_wallwork Active Member

    I work in the NHS and we have recently strted using single use instruments. We do not give them to the pt and we are not supposed to give them to the pt. i think some people have given pts the file to use. I am aware of another trust giving the pt their own set of instruments for them to bring every visit. however i do believe they are in some sort of sealed bag so the pt cant be tempted to use them. and i think they also have the policy if the pt doesnt bring them with them they dont get treatment (so the trust doesnt have any spare). Im not sure if there is a cost to the pt for the instruments but i did hear that they were charged £5 for them, how true this is i dont know.

    Hope this helps

  3. David Smith

    David Smith Well-Known Member

    IMO. The disposable instrument thing is ridiculous in many ways not least in terms of sustainable resources .

    The corporate mind of the NHS is completely deranged. Each rational, logically thinking person within the organisation could not possibly come up with and believe in such preposterously absurd ideas and yet as a community they are insane.
    As well as being corporately insane they are individually castrated and impotent. Everyday I hear winging complaints about internal policy and regulations from friends and family who work in the NHS and yet none of them have the bottle to stand up and make a change. Even if they do the next manager up the line has protocols to quash and whitewash the process into obscurity.

    One of these for example are target hitting objectives, these are not set in terms of what is best for the patient but rather in terms of how to stop the target clock and avoid punitive fines. One of the latest ones is that a certain group of doctors must see patients for their initial consultation within a set number of weeks. So the plan is get every patient in for a 5 minute 'clock stopping' consultation and then send them away with a second appointment that will deal with the real problem. On paper everyone has been seen on time, boxes ticked all is well with the paper work. Except that now the patient has travelled to hospital for no reason and wasted their time and the doctor and all the staff have wasted their time and public money just to hit a target. And instead of standing firm and saying we are not putting up with this ridiculous situation, everyone moans at their husband or wife and puts up with it.

    My useless ineffective rant for the day, regards Dave Smith
  4. nigelroberts

    nigelroberts Active Member

    It would be interesting to see the Trust defend the re-use of single use instruments. I would have thought the person responsible for infection control across the trust may have a view!
  5. cornmerchant

    cornmerchant Well-Known Member

    The instruments given to patients in my Trust were as far as I could see when shown a set by the patient, disposable/single use instruments. This infers that the trust were happy for the patient to hold them for self use without sterilisation. The main point of single use is just that- in an NHS setting they are used and thrown away.These instruments should not be sterilised under any condition and reused for another patient. However, we all know that single use instruments will last for a long time for personal usage, and it is ethically and environmentally unsound to promote their use. Thats another thread!

    It would of course be very hard to prove that any infection resulted from the instruments especially if they were only used for the same patient, and a test case is very likely to be forthcoming. What exactly is the risk anyway? We are talking just nailcutting here. I doubt whether the pods involved have the prerogative of being allowed to give an opinion or defy the bosses!
    I am mighty glad I am in PP and have control of how I run my own practise!

  6. Graham

    Graham RIP

    I am quite sure should a patient experience an infection post nail care,, having used instruments they had been holding, that the practitioner would here from their lawyer. Also, I would be concerned for myself. Although in frequent, it is possible to injure your self while using any instruments. Would you wish to expose your self to "who knows what" from instruments kept at home by patients?

    Despite the obvious environmental issues this would appear to be another hazardous situation. Perhaps?
  7. SarahR

    SarahR Active Member

    Hospitals in Canada used disposable surgical tools for a while. Not everyone switched over, having the foresight to realize that a few people's salary saved would not necessarily pay off in the end

    Many are returning to quality instruments taken care of by in-house staff. Hoping your NHS soon sees the light.

  8. airamasor

    airamasor Active Member

    I don't know about the person in charge of infection control, but I did hear the head of the department (big boss) saying that there was not problem giving patients the instruments and it was not ilegal. This is because these instruments would not be used in other patients.
  9. airamasor

    airamasor Active Member

    If I was the patient, I would not like to be treated with "dirty" instruments. Let's not forget that accidents do happen.

    Also, how can they know these instruments have not been used in other people while under the patient care?

    I am working towards getting my practice acredited, and in the documents state clearly that instruments need to undergo the minimum disinfection standards. That is, they need to be clean and then sterilised before use. I would imagine that all podiatrists, regardless of their place of work, would like to comply with these standards.
  10. cornmerchant

    cornmerchant Well-Known Member

    I fully agree that we all try to comply with decontamination standards, however it seems that in this case the boss has said it is ok to re-use the instruments that have been supplied for personal use therefore the boss surely would be accountable in the case of litigation.
    This is not going to affect your accreditation process since you do not undertake the practise of reusing disposables.

    When I asked 'what is rhe risk" I really meant "what is the risk"? Is there evidence to say that that this practise really does result in problems or is it an assumption on our part ?

  11. neilnev

    neilnev Active Member

    Good morning colleagues.

    Firstly, I would humbly and politely request that some of you remove your heads from where the sun don't shine.

    My beloved PCT has, IMHO, taken the correct decision to give patients nail nippers, to be brought back when they return for any further treatments. Let's look at the reasons. We have our own excellent quality instruments that are packed and recycled by a firm in the Preston area. The cost for a basic pack of instruments to be cleaned, sterilised and repacked is approx £4.20. The cost of basic single patient use nippers, which are capable of 2 years of usage (approx 6 - 8 cuts) is between £1.75 + £2.75. The cost of a disposable nail file is approx 10p. The cost of a disposable sterile blade is approx 6p. (Please note single PATIENT nippers NOT single USE nippers).

    Let me ask you a question - do you autoclave your own personal nippers when you cut your own toenails? (Those of you who have answered yes probably need some therapy). Probably at least 75% of nail cutting that is carried out, is carried out on non-pathological, simple nails, perhaps slightly thickened in some cases. Now most pods use Azowipes (or an equivalent wipe) to clean their units, chairs etc. I would suggest that you check on the action and effectiveness of these wipes. We will be wiping the nippers pre + post op with a wipe. Again, for you naysayers out there, I have discussed this with a consultant microbiologist who is in full agreement that this is a completely safe practice. Of course, we will be giving written instructions to the patients. Also, we will not be giving them to patients with nail infections or severely hypertrophic nails. But, frankly, there are massive savings to be made and sadly, in these days of vicious cutbacks, one must use all methods available to safely save money.

    I suggest that you should also look at the following website - www.caremart.co.uk. Caremart are a social enterprise of non-clinicians who have been given one day of training re: nail cutting (without prejudice - this is what I have been told) and they are touting for business, at least in the north west of the UK. They charge (to individuals) £!9 for a 1st visit + £9 thereafter £25 for a couple + £15 per subsequent visit and, in nursing homes, £16 for a 1st visit and £6 per subsequent visit (including (sic) "a personal set of cutting instruments" in all cases).

    I have been qualified since the middle ages and I remember when footcare assistants were first mooted. Well we learnt to live with them, and we'll have to learn to live with patient held cheap and cheery single patient nail nippers (remember, re: litigation - not single use). Welcome to the 21st century (whether you like it or not).

    Have a wonderful day.
  12. Catfoot

    Catfoot Well-Known Member

    Hi Neilnev,

    I do, so where do I sign up?

  13. neilnev

    neilnev Active Member

    Do cat's feet have more of a risk of cross infection then?
  14. blinda

    blinda MVP

    :D:D C`mon....made me smile anyway
  15. Graham

    Graham RIP

    So have I. But professionally and ethically You sound like a foot care nurse not a podiatrist! If you want to be portrayed as that then I the profession in the UK is just what you portray. Do you want to be regarded as a medical professional or a pedicurist?

    Glad I left now!
  16. neilnev

    neilnev Active Member

    Now, now Graham. If you read my cri de coeur, I commented on the pragmatism behind the use of giving nail nippers to patients. The reality behind it, from the clinical point of view, is that we have sufficient funding available to be able to carry out the advanced procedures that we are trained for. Having said that, please do not demean the role of good nail trimming in the comfort of patients. There was a thread on here last week about that subject, and frankly, I don't want to be repeating myself on that subject. Is a GP a glorified nurse because he takes a patient's BP? No, it's just part of his day to day job.
  17. Graham

    Graham RIP

    Sorry, I should have said that "routine" nail and foot care is probably 30% of my practice. It is not the practice of cutting the nails that is the problem. It is the impression given, both to the public and other health care professionals, when using sub standard instruments and sterilizing .
  18. Graham

    Graham RIP

    I wonder how many GPs would hand out patient specific speculums for patients to look after themselves?
  19. neilnev

    neilnev Active Member

    Don't give our commisioners any ideas!
  20. Graham

    Graham RIP

    Could open up all kinds of avenews, for savings that is!:drinks
  21. neilnev

    neilnev Active Member

    Self monitoring of glucose levels, BPs - maybe not speculums.
  22. Tuckersm

    Tuckersm Well-Known Member

  23. Lizzy1so

    Lizzy1so Active Member

    I looked up caremart 55 as sited by neilnev, couldnt find out alot about them, and there didnt seem to be any information on their training or standards and no way of contacting them from their website. A bit of digging, not much as on my way to work, seems to indicate support at PCT level. You can bet that someone is making money out of "social enterprise" what is that anyway? Feeding my family is a social enterprise, is their executive director Steven Tomlinson working out of the kindness of his heart?I doubt it, be brave and stand up to dumbing down. Why are our nhs collegues happy to refer to poorly qualifed nail cutters and not to us?

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