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Facets
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Infection
Control - Cleaning of Instruments
by
Laura Roehrick, RN
Volume 101
Introduction: In Volume 93 of FootZine
I asked for your procedures and protocols for
instrument disinfection and sterilization.
One response was from Laura Roehrick, RN, who
described her procedure for her own
routine-care instruments and also sent along
the Canadian Infection Control Guidelines.
Since that time, Laura has sent three related
documents from her Administrative Manual.
This issue's Facet reproduces her protocol for
Cleaning of Instruments. Future issues
will feature Laura's Infection Control
Guidelines and her Sterilization Procedures.
~ Gayle
Infection
Control - Cleaning of Instruments
Purpose: To provide
a method of cleaning instruments to remove any
debris, prior to sterilizing them.
Procedure:
* Protective eyewear, face mask and
gloves are to be worn while cleaning
instruments
* Mix 5ml. Of Miltex Instrument Cleaner
in 2 litres of warm tap water
* Soak instruments for 20 minutes Use a
soft brush to scrub instruments to remove
debris
* Rinse instruments under running water
* Place instruments on towel to allow to
dry thoroughly
* Rinse empty container thoroughly
* Read and be familiar with MSDS
Miltex is specially formulated to clean and
condition stainless steel instruments.
Miltex contains powerful detergents,
wetting agents, rust and metal inhibitors,
chelating agents (to remove mineral deposits)
and a lubricant. Miltex is
biodegradable.
Risks:
* May cause eye and skin irritation
* May cause throat, mouth and stomach
irritation if ingested
* Repeated inhalation may result in
sensitization and allergic reaction in
hypersensitive individuals
Precautionary Measures:
* Avoid contact with strong oxidizing
agents (bleach)
* Long exposure of product to heat
and/or humidity may reduce product's activity
* Store in cool place
First aid Measures:
Contains alkalies that can cause burns to eyes
and nose. Prolonged exposure to
concentrate solution may cause burns to skin.
* Eyes: Flush immediately with
water for 15 minutes. Seek medical
attention.
* Skin: Wash with soap and water.
* Inhalation: Seek fresh air.
Consult physician if allergic response
exhibited.
* Ingestion: DO NOT INDUCE
VOMITING. Contact local Poison Control
Centre.
Laura Roehrick, RN
The Foot Care Nurse
Santa Rosa, CA
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To
download a printable version of the above
handout as a Word document: LRoehrick_Cleaning_Instruments.doc
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Diabetes
and the Feet
Volume 97
by Hal Ornstein, DPM
All of us are likely to have problems with our feet, but
diabetics may develop serious problems more quickly and have
more complications, especially when circulation or nerves are
impaired. A random survey of diabetic patients in the outpatient
clinic of a Veteran's Administration hospital found 50% with
circulation and nerve damage plus some type of foot deformity. When
circulation is poor, the tissue is less able to fight
infection. When nerves are impaired, an injury can
occur without pain and as a result, may go unnoticed.
The key for the diabetic is to view all foot problems as potentially
dangerous and to prevent them and seek podiatric care as
soon as they occur.
Except for blindness, the complication most heard about
diabetics is loss of a leg. This widespread concern is
realistic.
--30% of all diabetics have peripheral vascular disease.
--Of all non-traumatic amputations in the U.S., 50% to 70% are
performed on diabetics.
Poor circulation often happens in diabetics, which
can lead to serious complications. Chronically tired or painful
feet may mean circulation is poor. Symptoms such as numbness,
tingling, cold or blue feet, and swelling that will not go down
indicate poor circulation. Cramping may occur at night, during
rest, or while walking a short distance. Smoking and stress
usually increase the severity of the symptoms. Examination by a
podiatrist will reveal any circulatory deficiencies.
Diabetic Neuropathy can cause insensitivity or a
loss in ability to feel pain, heat or cold. If precautions are
not taken, a hot bath can be a potential for a burn. Position
sense is often lost in neuropathy, so the feet scrape objects in
their path. Diabetic neuropathy can also affect the muscles of
the feet causing deformity such as hammertoes.
When insensitivity is present, serious problems, such as ulcers
and gangrene, can occur without pain. The infection may go
unnoticed and appropriate care may be delayed until too late. By
the time the trouble is discovered, amputation may be necessary
to save the person's life. Daily observation of the feet is
necessary by a diabetic or a responsible family member or other
party.
Ulcers can be caused by lack of blood circulating
to the foot, lack of soft tissue protection, excessive callus
tissue, infection, and pressure points caused by deformities.
Some causes of injury and ulcers are wearing ill-fitting shoes,
performing self-surgery, applying electric heating pads or hot
water bottles, and using ingrown toenail and corn remedies. If
the circulatory response is adequate, most diabetic ulcers can
be healed if diagnosed and treated early.
Skin changes in the foot can be caused by
diabetes. Dehydration is common since the diabetic has less
natural lubrication than the non-diabetic. Fissures and cracks
in the skin develop and often itching can become severe.
Scratching can cause breaks in the skin that may become
infected. Dryness can be helped by using a good skin cream daily
on every part of the foot except between the toes.
Cuts, Scrapes, Blisters, and Puncture Wounds can
cause serious problems. To prevent such injuries, diabetics
should always wear some kind of footwear. If foreign bodies,
such as splinters, become lodged in the foot, or if an infection
or puncture wound occurs, the diabetic should be treated
promptly by a professional.
Ingrown Toenails can cause infections, which tend
to be especially severe in diabetics. To treat the problem, the
podiatrist may drain the infection to relieve the pressure,
prescribe an antibiotic, and recommend special home care to help
the infection heal.
Athlete's Foot is a fungal infection common in
diabetics. If it or other skin rashes are not promptly treated,
secondary bacterial infections that require vigorous treatment
with antibiotics may develop.
Structural changes in the feet of healthy adults
may also occur in the feet of diabetics and these problems can
be far more serious because the disease causes changes in the
nervous system. These changes in turn may prevent the diabetic
from experiencing or expressing pain or discomfort and will
require evaluation on a continuous basis to prevent serious bone
and joint changes.
Important Diabetic Foot Care:
1. Do not ever walk barefoot.
2. Do not wear any shoes with open toes, soles or heels. Be sure
to wear shoes or slippers with firm soles, especially outside of
the house, in your yard or at the beach or pool.
3. Wear shoes that fit snugly but not tight. There should be ½
inch between the big toe and the shoe. The toe-box should be
round and high to allow space for toe deformities. The upper
portion of the shoe should be soft and flexible. The lining
should be smooth and free of ridges, wrinkles and seams.
4. Rotate your shoes every day and keep your shoes in good
condition.
5. Break in new shoes gradually and wear for only a few hours at
first to prevent blisters and sore spots. Check your foot for
red areas indicating too much pressure.
6. Check inside your shoes daily for sharp edges and foreign
objects.
7. Do not soak your feet. This causes too much moisture between
the toes and Athlete's foot.
8. Carefully and gently pat your feet dry (DO NOT RUB). Use a
soft towel and remember to get in between all your toes.
9. Use moisturizing cream in small amounts and massage into feet
well twice a day. Do not apply between toes.
10. Do not pull off loose pieces of skin.
11. Wear clean socks, change them daily and discard when worn
out.
12. Inspect the socks daily for signs of drainage from an open
sore that you may not realize you have because you cannot feel
it.
13. Keep your toenails trimmed. Since you are diabetic, it is
recommended that you visit a podiatrist regularly for cutting of
your nails.
14. Do not attempt to trim you own corns or calluses.
15. Do not use commercial corn or wart remedies. These contain
harmful acids that are very dangerous to diabetics.
16. Avoid extremes, such as cold or heat, and if your feet are
cold, wear warm boots. Never use hot water bottles
or heating pads.
17. Always avoid wearing anything tight around your legs or
ankles that may in any way reduce or cut off the blood supply to
your feet.
18. Do Not Smoke! Smoking constricts the blood
vessels and directly affects the blood supply to your feet.
19. Do not cross your legs. It decreases circulation.
20. Do not expose your legs to prolonged sunlight.
21. Do not apply adhesive material such as moleskin or adhesive
tape to the skin of the feet without first consulting your
podiatrist.
22. Most importantly, examine your feet daily, including between
your toes. If you have a difficult time seeing your feet, have a
family member or friend do the inspection. If you find any
sores, cuts, redness, swelling, pus, or blisters (EVEN IF
YOU HAVE NO PAIN), report this to our office immediately.
If our office is not open at the time of your call, follow the
instructions to reach us by beeper. We will then contact you
shortly.
PLEASE REMEMBER, PREVENTION IS THE BEST MEDICINE!
Please have your family members review this information.
Hal Ornstein, DPM
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To download a printable
version of the above handout as a Word document:
Dia-Feet-Hal.doc
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