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Terence Mitchell Case: HCPC

Discussion in 'United Kingdom' started by Simon Ross, Feb 19, 2013.

  1. Simon Ross

    Simon Ross Active Member

  2. fishpod

    fishpod Well-Known Member

    read the 39 pages wow this solicitor is awesome perhaps oscar pistorious should hire him .
  3. David Smith

    David Smith Well-Known Member

    Yeah read thru that and was quite bemused that the HCPC representative seems to say that if the registrant denies any culpability then he must not understand the seriousness of the misconduct and so therefore must be unfit to practice?? Sort the bones out of that crazy logic!!:dizzy:

  4. davidh

    davidh Podiatry Arena Veteran

    On a more serious note, this could happen to any of us - the complainant was unable to attend, the chiropodist friend of the complainant who advised him was not called to attend, the Home Manager didn't attend, and yet the case still went ahead, based on hearsay, albeit documented hearsay.

    The BCPA legal people are, I'm pleased to note, very thorough.
  5. fishpod

    fishpod Well-Known Member

    dear dave i think you are missing the point the chiropodist in question admitted to using 1 set of instruments un autoclaved or single use on 3 to 4 patients and said he did this routinely. if an nhs pod did this they would be sacked this does not meet minimum standards of sterilisation i think that the witnesses wife dying did the pod a huge favour.
  6. David Smith

    David Smith Well-Known Member

    I do understand that point fishpod and I agree it is not recommended practise and personally I always goto Doms with enough prepacked sets of instruments for the number of clients I will see at on the day. However, the defence established that there was no hard and fast recognition regarding what constitutes sterilisation in terms of this case, which I believe may be an important precedent for future cases to be aware of.
    I also think that this indicates that just because the NHS has some protocol it does not necessarily mean that protocol applies to all podiatrist (which in my opinion is a good thing)

    Also this raises questions about what standard of sterilisation is necessary, what are the real risks and why do we need ever increasing standards?

    E.G. those same people don't have their bath sterilised (i.e. microbes reduced by 10^6) between each person using the bath or the toilet or the shower or the wash basin or walking on the same floors in bare feet ( and if you do this type of DoM you will know what is often stuck on the bottom of the feet.)

    So then if you are just cutting nails I doubt that the risk of cross infection and the reality of cross infection is any more than in the above examples and probably a lot less if you use tools cleaned between patients using alcohol & chlorehexadine for instance.

    Not best practice by today's SCP guidlines I'll grant and individual sterile bagged instruments would avoid the possibility of prosecution but a reasonable case can be made and was in this case.

  7. fishpod

    fishpod Well-Known Member

    dave i think you are probably correct in your assumptions regarding the legals. the member concerned showed a lack of insight and failed to keep up with current best practice. i dont think we cross infect much but with aids hepatitis and cjd we really should ere on the side of safety. i feel we owe this duty of care to our patients. If a podiatrist advertised by saying by the way i dont really use sterile instruments how many clients would they get.
  8. DTT

    DTT Well-Known Member

    So why are there still so many fluids on the market in various application forms ie wipes/ liquids etc that claim to make your instruments clinically clean ??

    They have been around for years an certainly when I qualified that was the way to go by immersion ( after stropping and honing your solid scalpels) but that was many years ago.

    I also believe methods used are published by all as a " recommendation" not a "directive" so does that not leave open the interpretation as to what suits your patients in a particular scenario provided that method is effective ?

    I make the guy right on the attitude of some homes, where on in one breath they are talking cross infection and the put you in a carpeted room with all sorts on the floor and in the chair and stuck / running over the patients with no back up. I've worked in some of them in the past when I did doms thankfully without incident.

    Is there a suggestion that this complainant who's mate was a chiropodist was trying to get his mate into the home as the chiropodist?

    What easier way to do it that by making a fictitious allegation to the hcpc without the courage to attend and back it up. If I was a cynic I might wonder if any money changed hands in the process.:rolleyes:

    I agree with Dave on this one there is far too much emphasis put on instrument "sterility" when we all know "clinically clean" is the best we can ever hope for at point of patient contact and that is in a surgery situation. With doms ..who knows because the environment your working in , patient hygiene, continence, animal droppings all play a part.

    The bottom line is if they had found this guy guilty there would have been a mass outcry of FOUL ! because of other practitioners not sterilising at all by any other means than immersion albeit some unregistered, and if that were implemented the full fee would need to be charged by pods in all homes and sensibly how many pods would survive a fee increase to cover the costs of disposables , vacuum autoclaves etc ?

    DH had a good point I make the defending solicitor brilliant as well :drinks

  9. fishpod

    fishpod Well-Known Member

    dtt just because when i trained i soaked in chlorhex doesnt mean i should do it now. just advocating best practice not cheapest i can get away with mate. i was sure most pods adhered to these high standards . i am wrong because lots of people are suggesting we go back to wiping our instruments on the back of our trousers. ill bet most valuable poster you know who i mean doesnt agree with using sterile baby wipes to sterilise his kit.
  10. DTT

    DTT Well-Known Member

    Perhaps not but he may use them to clean the inside of his oven !! ?? think about it.

    I use a vacuum autoclave which is the next thing to sterile equipment for all my patients but I'm enough of a realist to know there are practical situations that some would find immersion / disinfectant wipes more practical and according to "what it says on the tin" are fully effective against all the organisms we would come across, so who's to say that one is more effective that the other ??

    Which system do you use out of interest ?
  11. I think from reading the closing argument for the defence, that the registrant's case was immeasurably strengthened by weakness in the panel's approach insofar as there was no effective counter- argument regarding sterilisation or best practice for domicillary visits. That said, I wonder how many visiting podiatrists have individually bagged sets of sterile instruments for their practice? Or what about nail burrs. A cursary inspection of most NHS clinics will find multi-used burrs in most drills that might not have been changed for weeks or even months...
  12. fishpod

    fishpod Well-Known Member

    dear d i use a mixture bagged autoclaved ie vacuum autoclaved and disposables particularly useful in care homes et al. all instruments are washed ultrasonically cleaned dried then autoclaved . all the packs are used within 3 months. all the disposables go into sharps containers and are disposed of by a regulated company. i only ever use disposables for doms.
  13. DTT

    DTT Well-Known Member

    So how do you know your disposables ( hideous clumsy things from what I've seen) are properly / effectively steralised ? except by what you are told ??
  14. fishpod

    fishpod Well-Known Member

    simple really derek the company is in the nhs supply chain has an eso number and ive seen the clean room they come out of . and a little trust in my supplier . they could of course be running a scam and covering my disposables in horse meat.
  15. DTT

    DTT Well-Known Member

    So you have no trust in the manufacturers of the immersion type fluids disinfectants that make the same claims as you then ?

    And because it is in the nhs supply chain does not instil me with confidence bearing in mind the infection risks in ALL departments of the nhs and the cheapest rules in the supply ,which IMO encourages cutting corners to meet costs.

    I don't trust anybody personally and do everything to do with steralising myself so I know there are no corners cut .

    So who's right ?
    You tell me
  16. W J Liggins

    W J Liggins Well-Known Member

    Really, this all comes down to the Bolam Principle which stands as UK law regarding medical treatment. The point being that the defendant did not have to prove that he was following best practice; certainly not NHS practice (and I have seen that that is variable in any case) but only that he followed practice carried out by the average colleague. I strongly suspect that wiping or immersing instruments in chlohexidine/alcohol would be seen as appropriate and standard practice by many practitioners carrying out nursing home visits and, if this is so, then he is acting according to law.

    Just to be slightly mischievous, since many such visits are carried out by FHPs, then presumably the law would regard them as legitimate practitioners, and therefore also falling under Bolam. I'd be willing to put money on their not using steam sterilisation as a general rule. If this is the case then it is another example of the HCPC being powerless to protect the patient!

    Bill Liggins
  17. DTT

    DTT Well-Known Member

    Just my point Bill :drinks
  18. I still like the idea of trimming nails with horse meat though.
  19. DTT

    DTT Well-Known Member

  20. louisa50

    louisa50 Active Member

    When I was a sister in a private hospital I sacked a chiropodist for "sterilising" their instruments in the way described (not the horsemeat...the other one). I think it's disgusting beyond belief.
    The thought of somebody cleaning my sulci with the same instrument that was used to clean someone else's a short while before makes me feel sick.
    I recently bought a disposable podiatry pack and it was horrible, thick clunky tools that are pretty lethal in the wrong hands.
  21. Interesting replies. I have about seventeen sets of instruments that are cleaned ultrasonically and autoclaved in bags. I work wet - with 90%IMS in autoclavable trays and change each set for every patient. It's just easier and it cuts out a lot of work at the end of the day. As for necessity..... I once did a partial avulsion without phenol matrixectomy with a swiss army knife that had been in the bottom of a rucksac for several years - unsterilised - in a tent on a Norweigan Glacier in the middle of the night with melted snow and a pair of torn up knickers (used) for wipes. And it healed uneventfully.

    I don't think I've ever cross infected a patient in thirty years - whether cold sterilisation or autoclave was used. Our immune system is usually quite effective despite our careless attempts to fool it.
  22. louisa50

    louisa50 Active Member

    Funny you should say that Mark, I once had a patient with multiple ischaemic ulcers who we had treated week after week without any reduction in size, vascular referral etc etc then one week she went awol and disappeared for about 2 months.
    She finally returned with the original dressings still on but a tad grubby by now as you can imagine.
    I took them off with trepidation expecting gas gangrene at the very least and they were all healed up underneath, I suspect aided by the primordial soup created under the eden project of her dirty dressings ;)
  23. DTT

    DTT Well-Known Member

    WHY did you sack the chiropodist ??

    As an employers ? employee? you have the right to set your company standards albeit they are out of step with this profession and that is part of the problem.

    People that don't know anything about podiatry making inappropriate decisions on what they perceive to be right or wrong without checking the facts perhaps ?? and in the process taking away the livelihood of a practitioner who as in the case described above had been working for 12 years without a problem :confused:

    What are your sterile instrument standards for someone that has the power to hire and fire Louisa50 please describe ??

    Perhaps in the situation as described in this case where the predominant Tx was simple nailcare, would your action be the same ?

    Did you give the chiropodist adequate facilities to treat the patients properly ( see above) ??

    Did you give them adequate information and assistance in the patients history and well being during Tx ??

    Did you actually raise your concerns BEFORE wielding the axe :butcher:

    Mind you I do make you right on the disposable instrument point...Bloody awful things no finesse or touch with them a definite no no for me but..

    How do YOU clean your instruments ????

    Lets hear your comments ( along with Fishpods reply)

  24. Lovefeet

    Lovefeet Banned

    Hi Louisa......I only use single use instruments. Have to agree the nippers in a basic pack are not easy to use. But try using single use ingrown toenail nippers....they work a treat, for cutting all types of toenails (not just ingrown).
  25. louisa50

    louisa50 Active Member

    It wasn't as simple as that DTT, there were many other things going on I just couldn't be bothered to go into it all. This lady had only come once before, our ward was on her rounds of loads of other hospitals and nursing homes. She was self employed.
    Her general hygiene practices were appalling in every respect and podiatry skills non existent.
    There was far too much going on to give her a second chance - I think complete retraining would have been the only option.
    Quite honestly if someone comes in and is obviously incmpetent I am not going to give them a second chance, I'm not here to nanny idiots. I expected a professional and didn't get one.
  26. louisa50

    louisa50 Active Member

    Not washing hands between patients at all
    Leaving everybody with bleeding feet including diabetics and ischaemics and not applying a dressing just letting them bleed into their shoes
    Going off for a fag every two patients
    Appearing unkempt and unwashed
    Being rude to patients if they didn't move quick enough
    Being uninterested in the patients history
    I could go on.
    Also having just two sets of instruments soaking in jars and using those two sets on everyone

    We send all our instruments to central CSSD at the hospital.
  27. DTT

    DTT Well-Known Member

    So she had come once and you formed an opinion that( she was an incompetent idiot that in your opinion needs complete retraining) you cant be bothered to explain here after posting your opinion and sacking her ??

    Sorry but that wont work on this arena.

    If you make a statement of that gravity and are challenged on it as I have done please have the courtesy to explain your statement and reply to the questions asked fully and in detail so that lessons can be learned by all under scrutiny from your peers as to your expertise in podiatry that drew you to that conclusion and your own standards of sterility in your present situation.

    I await you full reply ( along with fishpods) to my questions
    D ;)
  28. Boom Boom. Sometimes you wish these big lumps of iron that are wheeching by out there between the stars had a slightly different trajectory. Seemingly the big bang over Siberia last week - if it had just been one minute later and ten feet higher, it would have obliterated the entire south east corner of Blighty. That close. Instead it just ploughed straight into the ice in the middle of nowhere. What a waste. If there was indeed a God surely he would have consulted with Issacs to get the trajectory correct!

    It's always the one's you never expect that get you in the end, Derek. It's the same for everybody.

    87°14'19.72"S, 85°38'15.09"W
  29. DTT

    DTT Well-Known Member

    Sorry obviously cross posting.

    We being whom that sends instruments to cssd ??

    Are you speaking as a nurse or a podiatrist ??

    Everybody with bleeding feet without dressings ??????????????????? RUSure ??

    If that is the case the n hcpc hearing should be on the cards did you report it ??

    What do you do in relation to sterilising YOUR instruments that you use as a podiatrist.

    I have had experience of a nurse / chiropodist that took her two dogs with her when visiting a home and between patients ( tea and lunch breaks) took them out of the car to walk them and smooth them down.

    She stunk of dogs and was covered in dogs hair on her clothing and virtually every patient I took over from her had sepsis in some way or another.

    She left of her own accord and I cleared up her mess she left behind so my point is yes there are practitioners around that do not come up to an acceptable standard.


    In the case involved I'm not sure this chap fits that bill as he made an attempt to sterilise his instruments by immersion / wipes( as did your example) which as I said before may or may not fit the bill for an acceptable standard in the situation he was in.

    That is up for discussion here
    Last edited: Feb 20, 2013
  30. fishpod

    fishpod Well-Known Member

    hi derek , i think you are asking how i get on with disposables. I have no problems the nippers are exactly the same as reprocessable ones some of the joints can be stiff you can oil them with drill oil etc, im busy so just throw them away and open another pack . this is rare though.the more you use them the less you notice any difference ive used them for 3 years. i researched all the gear on the market and picked the right product for me.hope this explanation is reasonable. regards fishpod.

    sorry derek what do i think of imersion fluids i think they are crap mate and would never use them as they dont meet scp minimum standards so i will stick to my current practices which my professional body recommend.if they advise me to the contrary i might change.
  31. DTT

    DTT Well-Known Member

    That is exactly the point I'm making, "you picked the product that is right for you" which in your opinion fits the requirement you need.

    So if another pod decides the immersion technique is more suited to their requirments then who is right ?

    Both methods are acceptable to render an instrument clinically clean ( according to manufacturers / service providers) so...Why was this guy pulled up by the hcpc ?

    I'm not sure that "oiling nippers" before using them constitutes clinically clean though albeit your wealthy enough to throw them away rather than oil them :rolleyes:

  32. fishpod

    fishpod Well-Known Member

    hi derek its dental drill oil in a spray dispencer which i use on my wet drill not engine oil dek.
  33. DTT

    DTT Well-Known Member

    Same as I use on my spray drill motor.

    I'm not sure its sterile though and it doesn't get on the burrs / discs or contact area's.
    Undoing a pack of disposables spraying them with any kind of oil involves handling the instrument excessively so how clean is that at patient contact?

    My instrument box joints are lubricated before autoclaving so the problem of sticky joints doesn't arise.

    So what's your take on immersion on dom work ok or not ??

  34. fishpod

    fishpod Well-Known Member

    definately a no no for me .i discussed this method with some of my patients yesterday evening. they were not impressed they think all instruments chiropody minor op speculum should all be autoclaved.
  35. fishpod

    fishpod Well-Known Member

    derek i conduct an annual infection rate audit particularly with nail op patients and i am audited and inspected annually by the pct infection control lead they can inspect private premises if asked . my infection rate is less than 3.5 percent. i would like it to be zero so something to aim for. i feel this evidence based practice is one of the reasons i dont use instrument dips etc.we have to adhere to these high standards to run aqp contracts so this is normal for me.
  36. DTT

    DTT Well-Known Member

    Fishpod your missing the point, my infection rates are less that you claim even with nail surgery but from what you state you are happy to trust disposable instrument makers claims that all their procedures are doing what they say on the tin albeit in truth the infection rates within the NHS post operatively are still pretty dire even with disposables.

    The manufacturers of the fluids /wipes make the same claims but this guy who has not had a cross infection in 12 years in that home and uses these fluids so is he wrong to use that method because he believes what it says on the tin and it works for him in his situation??

    If he is wrong why?

    If he's not then why was he subjected to this farcical enquiry ?

    Not forgetting the recommendation / directive issue I mentioned earlier

  37. fishpod

    fishpod Well-Known Member

    how do you know your infection rates do you just make them up, do you know if a patient attends thier gp after tmt and gets antibiotcs how does he know if he has caused an infection he like you has no access to thier gp records . if you do nail ops on higher risk patients they get infections off thier own comensal flora this cannot be totally avoided only risk managed.i bet youve also got a bigger faster one than me as well .you are as always right your words are like pearls before swine i sign off and bow to your super powers. its like conversing with the all seeing eye, i am not worthy. may almighty god grant me the power to be more like your goodself.please tell us where you get all this brilliantly accurate information from like nhs post surgical infection rates are dire ive not seen that report titled in truth please forward me a copy.
  38. DTT

    DTT Well-Known Member

    Its nice to see you know your place fishpod but don't be so precious and accept your not the only one that keeps figure and I have an open review policy on all my surgery pts that if they have any problems then they come back to me free of charge so I can keep track and treat them. Don't do many high risk here NHS still cover them at the moment so my risk factor is different to yours anyway.

    Look at the news fishpod that will tell you where the infection hotspots of the moment are and the published tables of post op infections are available to all.

    So perhaps now you will answer the questions I posed to you now you have calmed down ??:D

  39. DTT

    DTT Well-Known Member


    As it happens I've got a BMW X3 M sport since you ask :D:D:D

    Please calm down and answer the questions..

    chillax troll chillax just get back to the discussion or to the cesspit your choice :empathy:

  40. louisa50

    louisa50 Active Member

    Ok not wishing to be rude or dismissive because this can be a great forum in some respects especially with regard to biomechanics etc, I feel this forum has become rather aggressive of late with lots of personal comments between members and trolling, responding to trolling etc etc.
    I personally haven't got time to respond to numerous questions about my post and go through pages of HPC material to do so as i have many committments outside of here, so apologies for not responding to your points and farewell. I feel more comfortable at the moment not being here.

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