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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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