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Key Principles In Preventing Infection In Podiatry Offices

While infection prevention is heavily emphasized in the hospital setting, infection can be problematic in the outpatient podiatric medical office as well without appropriate preventive measures. The Centers for Disease Control and Prevention (CDC) and the Joint Commission on the Accreditation of Healthcare Organizations are aware that infections can spread while podiatrists are treating patients in the office setting.1

These two organizations formed a task force to evaluate and prevent the spread of infections in outpatient podiatric medical settings, and invited InStride Foot and Ankle Specialists to collaborate on the project.

What The Task Force Recommends For Podiatry Offices

The task force on the prevention of infections in podiatry settings we described above recently released the infection control guidelines and recommendations for podiatrists.2 The following describes the major points that can be expected to be part of the model for basic infection prevention and control based on the preliminary documents produced by the study participants.

1. Each podiatric facility should devote sufficient human and fiscal resources to develop and maintain infection control programs.

2. Each podiatric facility should have at least one person trained in infection prevention and control.

3. Each podiatric facility should have a manual detailing the policies and procedures for the practice to prevent and control infections. This manual should detail the needed supplies and describe the necessary protocols required for adherence to standard precautions (such as hand hygiene and the handling of sharps).

4. Podiatric facility personnel should review the infection prevention and control policies and procedures at least annually. These guidelines should include the need for annual facility risk assessments that will be designed to foster continuous improvement in infection prevention and control. Note that podiatrists practicing in “off-site” settings (such as rest homes and nursing facilities) are subject to the same standards of infection prevention and control that are required in office settings.

5. Podiatric facilities should maintain an ongoing collection, analysis, interpretation and dissemination of data regarding infections in the facility. This will include appropriate disease reporting, ongoing infection prevalence monitoring and the use of checklists to assess the adherence to infection prevention and control programs in the facility.

6. All employees of podiatric facilities with a role in infection prevention and control should receive periodic training in infection control and prevention to ensure that they understand and follow the policies and procedures of the facility.

7. All podiatric facilities should follow the applicable Occupational Safety and Health Administration (OSHA) and other safety guidelines regarding health care personnel. This includes the provision of all recommended or required immunizations (e.g., hepatitis B, MMR, varicella, TDAP and influenza) at no cost to the employees.

A Closer Look At Standard Precautions For Clinicians And Staff To Prevent Infection

The following points describe “standard precautions” that are the minimum infection prevention practices that apply to all patients in every podiatry care setting.

1. Hand hygiene, via alcohol-based hand rubs or by handwashing with soap and water, is a critical component of all infection prevention and control programs. We recommend the use of alcohol-based hand rubs as the primary mode of hand hygiene due to their broad spectrum of action and because they are faster and easier than proper handwashing techniques for improved adherence in most health care settings.

Always perform hand hygiene:

• immediately before contact with a patient
• before performing an aseptic task (such as preparing an injection) or before handling an invasive medical device
• after contact with a patient or objects in the immediate vicinity of a patient
• after contact with blood, body fluid or contaminated surfaces
• before moving from a contaminated body site to a clean body site on the same patient
• immediately after removal of personal protective equipment

Use soap and water when hands are visibly soiled, or after caring for a patient with known or suspected Clostridium difficile. Otherwise, use alcohol-based hand rubs. Apply the product to the palm of one hand and rub the hands together so all surfaces of the hands and fingers are covered until they are dry.

Supplies necessary for adherence to hand hygiene should be readily accessible in all patient care areas.
Podiatric facilities should periodically monitor and record adherence to hand hygiene protocols, and provide feedback to personnel regarding their performance.

2. Personal protective equipment should be available in a variety of sizes throughout the facility. Examples include gloves, gowns, face masks, goggles and face shields. All appropriate health care personnel should receive training in the indications and proper use of personal protective equipment.

3. Respiratory hygiene and cough etiquette are components of the standard precautions in podiatry settings. Address these topics with employee training and patient and family education efforts, particularly for those who exhibit the signs of transmissible respiratory illness. The availability of face masks, tissues, no-touch waste receptacles and alcohol-based hand rub dispensers in patient waiting areas is another important part of this infection prevention and control effort.

4. Safe injections and medication storage and handling are other key components of preventing the transmission of infectious diseases in the podiatry setting. Proper training and procedure review regarding the use and handling of supplies and the administration of injections are needed for all applicable personnel. Also discuss the handling of and precautions for the use of oral and topical medications.

5. Describe the safe handling of equipment and surfaces in detail in the infection prevention and control manual, and cover this topic in periodic training and review sessions with healthcare personnel. There should be routine cleaning and disinfection protocols that one should document and monitor. The handling of soiled linens and medical waste should have policies and procedures that are detailed, and staff should follow them when applicable.

6. Medical devices should be classified as either reusable or single use. Clinicians and staff should follow all available manufacturer usage, cleaning and safety guidelines. The facility’s infection prevention and control manual should clearly describe the procedures for the handling of all medical devices, including the cleaning and sterilization of all reusable items, and the proper and appropriate disposal of single use devices. There should be an ongoing program for quality control regarding the cleaning, sterilization and storage practices for all podiatry facilities.

In Conclusion

Podiatrists pledged on the day of their graduation never to cause harm to their patients. The strict adherence to the fundamentals of infection prevention and control, and the constant observance of standard precautions while practicing podiatry are part of that pledge.

Dr. McDonald is the President of InStride Foot and Ankle Specialists in Concord, NC.

Dr. Liao is the Infection Control Officer of InStride Foot and Ankle Specialists in Durham, NC.

References
1.    Wise ME, Bancroft E, Clement EJ, et al. Infection prevention and control in the podiatric medical setting. J Am Podiatr Med Assoc. 2015; 105(3):264-272.
2.     Centers for Disease Control and Prevention. Guide to Infection Prevention for Outpatient Podiatry Settings. Available at https://www.cdc.gov/infectioncontrol/pdf/Podiatry-Guide_508.pdf .

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By Kevin McDonald, DPM, and Gary Liao, DPM
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