06/26/2019    Allen Jacobs, DPM

Sterilization of Nail Nippers (Matthew B. Richins, DPM)

With reference to the issue of sterilization vs.
disinfection of nail cutting instruments, there is
a difference between the theoretical and
practical. Do you disinfect your exam chairs
between patients? How about counter-tops between
patients? Your Doppler probes or blood pressure
cuffs between patients? Do you wear sterile gloves
while handling your autoclaved nail cutters? Do
you discard all multi-dose vials 28 days after
initial use? Do you terminally clean exam rooms in
which you perform invasive procedures?

I was trusted by the Missouri Podiatric Medical
Society to prepare and present sterilization and
disinfection protocols to the state society
members, as such training is required every 2
years in Missouri. In fulfilling that obligation,
I conducted appropriate research on this matter.

Yes sterilization is the “gold standard “for
killing all forms of life ( eg: bacteria, fungus,
viral) but it is not required for daily practice.

Critical sterilization is necessary for
instruments which enter sterile tissues, cavities,
or the vascular system.

Semi critical disinfection provides a high level
of disinfection for objects that come in contact
with non-intact skin.

Non-critical disinfection in used for instruments
that come in contact with intact skin, nails.

Cold sterilization (actually disinfection) is all
that is required. The key is to utilize an
appropriate effective disinfectant. Wash off any
dirt or blood before disinfecting. Follow the
manufacturers recommended disinfection time
protocol.

There is no data to suggest that antibiotic
resistant bacteria are less sensitive to properly
selected and utilized chemical germicides,
including MRSA. Properly employed, the
concentrations of many disinfectants used in
practice are much higher than he MICs of these
organisms. The level of tolerance of these
organisms is very low. Again, it is important to
use the optimal concentration, clean
instrumentation of organic matter that may impede
exposure to the disinfectant, and follow the
suggested disinfection time. The disinfection
contact time recommended by the EPA for use
against HBV, HIV, M. Tuberculosis is 10 minutes
for most disinfectants. Multiple studies
demonstrate significant microbial reduction with a
contact time of 30-60 second for vegetative
bacteria, yeasts, mycobacterium, and viruses.

Perhaps those claiming the necessity to utilize
sterile nail cutting instruments for each patient
might point to incidents of disease transmission
by not doing so.

Adequate disinfection protocols are all that is
necessary for daily practice. It is practical and
appropriate.

Allen Jacobs, DPM, St. Louis, MO

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