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Yay or Nay: Use of Nail Drills in Australian Residential Aged Care Facilities

Discussion in 'Gerontology' started by Em3, Sep 21, 2014.

  1. Em3

    Em3 Member

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    Hello all!

    I have a topic that a number of my colleagues and I have been debating at length - whether or not podiatrists can or should use nail drills in a residential aged care facility setting.

    We have some hard fast facts about using drills - for compliance with Australian infection control standards, nail drills need vacuum extraction, they need to be used in rooms that have a ventilation/extraction system in place, serious PPE needs to be worn (goggles, FFP1 or FFP2 grade face masks, aprons etc).

    We have the logistical standpoint whereby the argument is that the vacuum extraction drills are too heavy and expensive for a mobile podiatrist to cart around in an aged-care setting - and likely too valuable to leave in the care of the facility between visits; using a portable hand-held drill like a Dremel creates the dilemma of not having any dust extraction at all putting both podiatrist and patient at very high risk of inhaling dust particles or having eye and skin irritation; the rooms in which a podiatrist treats in residential aged care are unlikely to have sufficient ventilation let alone an extraction system. All of theses points lead to an OHS/HR stance of "Not safe for the podiatrist, not safe for the residents being treated, ergo not allowed to use drills".

    But from the patient-treatment view, can we provide the best standard of care if we cannot provide treatment using a burr/mandril bit with sanding discs? I do know a lot of pods have ace nipper/scalpel/file techniques to battle gryphotic nails and of course scalpel technique learned at university then honed by practice deals with gnarly calluses and corns, however surely having the option of a drill to assist is better for the patients' treatments and for the podiatrists' wellbeing?

    We have argued for drills, against drills; from patient, podiatrist and company standpoints... Now we are at an impasse. I want to throw it into the Pod-Arena for further input. I have been through the forum archives and found bits and pieces but they are quite old threads (though most argue against the handheld-no-extraction-drills for good reason) and I was hoping for more up to date advice on current practice from those working in aged care or doing domicilliary rounds. Any and all comments would be greatly appreciated!

  2. Simon Ross

    Simon Ross Active Member

    Excellent points. I only use a dust extraction drill. DOM, don't use a drill. Too many pods are putting their lungs at risk in this DOM situation. Most patients can get to the surgery, they can get to the dentist!

    Dust extraction and proper mask is used!
  3. JefferyL

    JefferyL Welcome New Poster

    Hi Em3
    We do home visits and aged care facilities and take a dust extraction drill with us. Carry it in a case called a pilot case on wheels. At the ACF usually set up in the one area. Once set up get a much better result, for patient and practitioner.
  4. Em3

    Em3 Member

    Thanks Simon! Do you mind if I ask how many you would see on a DOM round? My colleagues and I were discussing the use of drills from the direction of a purely aged-care podiatry company, that is completing a higher number of treatments per day without a clinic/surgery setup to refer more obstinate nails back to.

    JefferyL, that's fantastic information, thank you so much - which country are you posting from and whereabouts did you source the pilot case on wheels? I have not seen one myself, only the heavily padded hard shell carry cases. As an average, how many would you see in a session for your aged care facility days?
  5. JefferyL

    JefferyL Welcome New Poster

    Hi Em3
    Yes in Australia,
    Case are available online, officeworks etc, called pilot cases or flight bags. The last one I had to trim away the compartments but fits a birchtold well.
    As to how many I see on home visits, usually allow 45 min.
    ACF is a different matter, some churn through patients but I don't. I work from a room in the centre and bring patients to me. That can take time in change over but not will to put my back out . Also drill and sterile supplies are set up ready to go.
  6. HayleyV

    HayleyV Welcome New Poster

    Treating bedside in nursing homes creates numerous OH&S hazards. The ergonomics for the podiatrist are terrible and often the lighting is poor also. I think it is far preferable for the nursing home to have a multi purpose treatment room with adjustable couch, decent lighting and a dust extracting nail drill . This will help overcome many problems. There are very few residents who would not be able to get to the room if the staff are willing to help with this. The room could also be used by physio, dentist etc.
  7. Simon Ross

    Simon Ross Active Member

    I agree there should be a dedicated room with a proper couch.

    Hairdressers have a dedicated room, why don't we!

    Patients say to me that care homes must be good work. My response, a lot of pods won't touch them as the pay is atrocious, and the working conditions are too!
  8. PowerPodiatry

    PowerPodiatry Active Member

    I did a three month stint working for a company that contracted me to 20 residents per day with no nail drill.
    I am relatively old so learnt to de-bride mainly without a drill many moons ago. Quality of work can still be high without a drill...having said that I use a dust extraction drill when clinic based.

    Now i work for a community organisation and my daily workload is less due to all the driving...I have a non dust extraction drill that I will only use in a well ventilated space with a mask when on the road...maybe use it once per week if that. The community clinic has dust extraction.

    So over thirty years of hand filing, grinding various parts of the anatomy i think that if I want a dedicated room at a RACF i will have to become a hairdresser.

    Looking after your health doing DOM work at my age requires dedication to the whole body...I have developed my somatic exercise routine which I call Tai chi Rehab so that I can get through the day with a smile on my face.

    In a nut shell...look after your health in anyway you can.

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