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07/02/2020 Robert Spalding, DPM
Do you grind mycotic or dystrophic toenails? (John Moglia, DPM)
I completely agree with John Moglia, DPM. If you are going to perform electrical debridement for ANY nail care service, especially fungal nails,it is imperative that you FIRST use not only a Dust extractor (found with JanL, Medicool, Erica's Files, etc. dust extractor systems... which by the way only captures approximately up to 70% of the dust based on my company's research) but also utilize an additional source 3 zone capture system which is not only critical to capture the residual ambient dust but are rated to kill sub- micron viruses such as COVID-19 and depending on its placement.
Most all exhaled breath between your work area on the patient’s feet and the patient’s face through Electrostatic, HEPA and VOC filtration which is captured very effectively and relatively quietly. I have used this system ve-y effectively for three years prior to COVID 19 and kept my practice open since day one of the crisis with this specifically designed source capture system which is also being used in dentists’ offices to allow them to reopen and reduce their even higher COVID 19 exchange potential as their work area is the mouth.
But here is the kicker for anyone performing routine foot care is that simple nail nippers will generate a HUGE amount of generally unseen dust by simple debridement of NORMAL nails and the type of nail nippers you use can reduce or enhance that amount. T he real message is that you need a source capture system for providing ANY ROUTINE NAIL CARE as most podiatrists don't know that providing non- burring i.e. nipper-only foot care can still expose you to long term chronic micro dust inhalation problems anyway,however, electrical burring magnifies that more than 10 to 20 times. I predict with this new information; OSHA will start looking at this with intense regulatory eyes. You will not see this dust from mechanical nipper-only-services during normal lighting in your office but the superior direct and indirect light from the LED light systems on this particular source capture system approximate a mini OR operating room lighting system which truly improves any diagnostic exam or any podiatric surgical service or routine nail care and enhances any skill set performance especially if the practitioner is a senior or highly vision dependent on eyeglasses or adjunctive vision aids. It is also what led to me discovering the dust generation issue between types of nippers. I have videos demonstrating this phenomenon that will be shared at DERM FOOT conference in October. It is my opinion those podiatrists who don't offer electrical debridement/burring will ultimately lose patients to those other practitioners of foot care who do perform that service as it offers a better result between visits and there are ways to offer it safely. An interesting unintended side benefit from this source capture system stems from the rare case where bromhidrosis/odiferous foot case or poor hygiene patient shows up in the waiting room, the sitting patients get up and scatter to the far corners and the office staff hustles the offending patients feet in a treatment room... a flick of the switch and in 30 seconds that odor is magically and completely neutralized by the system YES, is my answer to the other Mask question on this same PM release. I do need a break from my N-95 or KN-95 mask between patients sometimes, but it will potentially save your life in the short term and long term along with the other items mentioned. The N95/KN-95 masks do reduce the contraction of viral infections and additionally, the inhalation of dust from routine foot care.... so, if there is a silver lining to the COVID 19 for routine foot care. masks are not only helpful preventives but make the use of masks more frequent, acceptable, and now, actually fashionable. Standard Surgical masks to not work to prevent either problem as effectively but simply limit you contaminating a surgical site in the OR or Office. Is a standard surgical mask better than nothing for routine foot care?....YES. I can say that with more conviction than the team of medical experts that said “masks are not necessary” during the COVID 19 crisis. Finally to kick a dead horse, If podiatrists are continued to be considered the "experts" in foot careyou need to be autoclaving all your instruments...period and the use of EFFECTIVE HL surface disinfectants- period. QACs are simple detergents, should not be advertised as HL disinfectants in my opinion and per the CDC and other liquids for instrument disinfection don't work as advertised, are banned for inappropriate instrument "sterilization" in some US communities, the EPA allowable dilution mixing factors defy medical intelligence, QACs don't kill 100% any of the organisms you need to kill and don't meet the current redefinition of the 1968 Earl Spalding Classification systems that is still erroneously considered the Gold Standard of Disinfection when dentists abandoned that approach 35 years ago. It is shocking in this COVID 19 crisis most of the US medical system for medical offices and some podiatric teaching schools still depends on a system of disinfection written 52 years ago as much has been gleaned about bacteria, viruses, fungus, sanitation, disinfection, disinfectants and sterilization methods since then. Hospitals with updated infection control prohibit the old podiatric residency director’s approach of keeping a pair of nail nippers in your intern jacket pocket and whip them out to service patients in the I-ICU, MICU or SICU at will. The ACMFCE's "Deception in Disinfection" lecture series has the new simplistic chartered proposed national foot care standards if you want to view them in upcoming seminars. You, the licensed podiatrist and you the podiatric student need to deliver that foot care at the most professional level or get ready to hang up your nippers as other professionals stand by ready to provide routine foot care with more appropriate protection to the practitioner and to the patient as well. It is embarrassing to defend to my students that some podiatrists still take one pair of nail nippers to a nursing homes and service 30 patients a day and the patients are lucky if the "expert" podiatrist wipe the nippers off between visits with alcohol or a BAC wipe. Nurses shake their head when some podiatrists come through the door. It is not defensible in conversation, education or in a legal arena if a cited infection occurs.
The APMA is not an enforcement body and feels promoting national higher standards is a state issue, and they are tired of my phone calls and I am tired of calling, so I am encouraging each state podiatric association to adopt higher standards at the state level that you control.
Podiatry will continue to lose many levels of basic foot services if we all don't all work together for national standards in infection control for routine foot care. It is already happening now; we are not going to stop other practitioners from providing foot care but we need to reverse it by doing the basics better than the other upcoming providers of foot care. Robert Spalding, DPM, Signal Mountain, TN
Other messages in this thread:
07/02/2020 Bryan C Markinson, DPM
Do you grind mycotic or dystrophic toenails? (John Moglia, DPM)
A simple search of the global microbiological, occupational science, radiological, and infectious disease literature dating back 2-3 decades will reveal a plethora of citations in the potential dangers and actual incidence of respiratory illness from inhaled nail dust and the microbes that tag along with it. A British NHS study reveals 4x the incidence of asthmatic type illness amongst podiatrists.
If Dr. Moglia won’t be convinced until he sees dramatic numbers of lung cancer cases, which he won’t, then he should stop wearing seat belts and bicycle helmets. And another word to the wise, should any podiatrist be immunocompromised by any number of medical issues and or treatments, the risk is increased. But if you are looking for high numbers of cases, you are trivializing the suffering of a more than casual number of people.
McLarnon NA, Burrow JG, Price P, Aidoo KE, MacLaren W, Harper M, Hepher M, Edwards G (2005). "The controls of airborne hazardous substance in the healthcare environment", IOHA Pilannesberg: paper E1-1, 1-6
C Abramson, J Wilton, Inhalation of nail dust from onchomycotic toenails, J AM Podiatr Med Assoc 1985 https://www.ncbi.nlm.nih.gov/pubmed/2933510/
J G Burrow, N A McLarnon, Evidence based risk management of nail dust in chiropodists and podiatrists, Occup Eniron Med, 2006 [accessed 19/06/2019] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078 045/
Millar N A. The ocular risks of human nail dust in podiatry. PhD Thesis, Glasgow Caledonian University 2000 https://www.researchgate.net/publication/34503834 _The_ocular_risks_of_human_nail_dust_in_podiatry
Paul D Tinley, et al, Contaminants in human nail dust, J Foot Ankle Res, 2014 [accessed 19/06/2019] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937 521/
Ward GW, Karlsson G, Rose G, Platts-Mills TAE (1989). "Trichophyton asthma: sensitization of bronchi and upper airways to dermatophytes anitigen". Lancet 8643, 859-62
Bryan C Markinson, DPM, NY, NY
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