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Behind The Scenes - Clinic Hygiene

A patient had read my previous post on exceptional quality podiatry instruments and we had a conversation regarding in-clinic hygiene systems. This lead me to realise that it was a great opportunity to put together a blog post relating to the procedures start to finish in ensuring that Deva Podiatry Foot Health Clinic maintains top rated, highest standard podiatry practice in clinic.

So below stage by stage and related to the images above is the full process!

Note On P.P.E

Best practice requires that throughout the clinic sterilization process P.P.E .is worn by the clinician undertaking the sterilization of podiatry equipment. The process commences before the clinic opens and finishes after the clinic has closed.

Stage 1

Boil 3.5 litres of tap water and add it to the specialist distiller. Over the next 3 hours the distiller will maintain a boiling temperature of 100 deg C . This process converts through distillation, tap water into approximately 3- 3.3 litres of distilled water. Around 200ml of water is lost to vapour and what remains in the distiller is a residue of super fine particles/ scaling /minerals.This residue is removed from the distiller so as to allow the distiller to be clean for its next operation.

The distilled water is then utilised in 2 ways.

Stage 2(a)

Approximately 2 litres of distilled water is added to the clinic autoclave. Later in the day this will be utilised.

Stage 2(b)

Approximately 3.5 litres of distilled water is added to the podiatry clinic ultra-sonic cleanser. The ultrasonic cleanser is then set to achieve a target temperature of 75 degC. This target takes around 4 hours.

Stage 3

Immediately after each patient has been seen the podiatry chiropody instruments are placed into a dedicated vessel containing cold sterile distilled water. The instruments are scrubbed to remove any debris and prepared ready to be added to the ultrasonic cleaner. Each new treatment / patient requires a new set of sterilized instruments to be used in clinic. At Deva Podiatry Foot Health Clinic we have a supply equal to 2 days of patient requirements. When a clinic sterilization system is set up as a daily process we can ensure that our stocks of sterilized instruments are always at hand.

Stage 4

We set the ultrasonic cleaner to maintain a temperature of 75 deg C. The instruments are added to the tank with a small solution of cleaning agent and the programme is set for 25 minutes of sonic cleaning. ( My least favourite part as the machine creates a high frequency shrill!!!!!)

Stage 5

Once cleaned in the ultrasonic cleaner the podiatry chiropody equipment is ready for the autoclave. The instruments are removed from the tank of the ultrasonic cleaner and laid out across the dedicated autoclave shelves. The guidelines require that the instruments must be placed on to the shelves without touching another instrument. (This ensures that the steam can reach all surfaces of the instrument). When required toenail nippers are then lubricated with a medical lubricating spray.

The autoclave is the beating heart of the modern podiatry chiropody clinic. At Deva Podiatry we use an Eschmann Little Sister. Our autoclave is calibrated and serviced every 12 months by a specialised autoclave engineering company. It is fitted with a data-logger. A data-logger records and logs a set of values for each occasion that the autoclave runs through a cycle. The basic figures are that the autoclave should reach an internal temperature of 135 deg C for a continued period of 3 minutes and 15 seconds. If the autoclave cannot achieve this it fails its cycle, the error is logged and the autoclave must be serviced. The fail safe for this level of sterilization record keeping is that to be sterile and fit for purpose the autoclave has to pass its cycle and data log.

The cycle contains a drying cycle that removes most of the surface residual steam deposits. Any remaining deposits are removed with lint free disposable clinic sheets. At this point I can explain why distilled sterilized water is used.

The natural mineral deposits contained within tap water-even when boiled can effect the internal surface areas of the autoclave, water distiller and ultrasonic cleaner.If tap water was used for this process the steaming action under pressure would deposit residue onto the podiatry tools. The residue not only creates an effect of an instrument being "dirty" but it can also promote growth of pathogens over time.

Once the cycle is completed the instruments are finally ready to be bagged into sterile pouches. We date stamp each pouch. Best Practice Guidelines ensure that instruments can be placed in sterile pouches for up to 1 year. Our system of strict rotation ensures that podiatry instruments are sterilized and ready to be used in clinic for 1 to 14 days.

Some instruments are not used within a routine appointment. For instance specialist nail surgery instruments may only be used once a week and specialist ingrown toenail removal instruments may be used once or twice daily. The added benefit of a dating system ensures that such instruments are brought back into sterilization more frequently by utilising our 2 week expiry to renew sterilization policy.

We have dedicated drawers and storage systems for our instruments. The routine podiatry instruments are placed into one side of a drawer to comply with our rotation. The nail surgery instruments and ingrown toenail removal instruments have their own dedicated drawer storage system.

Not yet mentioned in the Deva Podiatry clinic sterilization and rotation system are the tools related to Fungal Toenail Treatment via The Lacuna Method. Fungal Nail Infection has the ability to spread and infect other toes. When it is identified as part of a treatment plan that fungal infection is present there is a need to proceed with extra caution. For example the primary purpose of the Lacuna Method is to eradicate fungal infection from infected areas of toes. Once a specialised tool has come into contact with such an area it is potentially contaminated with fungus and must be placed aside.

You can see and hopefully understand that the sterilization system within a clinic is thorough in its attention to detail. The procedures and guidelines are set by NICE and the College Of Podiatry to ensure that best practice clinical standards are adopted.

We are also required to keep additional records relating to our in clinic sterilization system to identify that it is fit for purpose.

Where we use single use instruments they are always disposed of in an appropriate manner, for example we use single use , highest standard, Sheffield Made Swann Morton Scalpel blades which are disposed of in a sharps bin- after each patient treatment.The reusable stainless steel handles are only ever used in an individual appointment. Each patient is treated with a freshly sterilized blade handle. At the end of the appointment it is placed into the clinic sterilization system.

It has been common practice in "pop up" nail bars to use files and instruments repeatedly through the day on numerous clients. For many the realisation that this is poor hygiene and sterilisation has never been a consideration.

In this year of huge changes our attitudes towards hygiene, sanitisation and sterilization have changed forever. Its reassuring to know that Deva Podiatry Foot Health Clinic has adopted best practice guidelines in clinic procedures and protocols that will allow you to feel that your feet are always in safe hands.!

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