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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
xcel


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