[Table of Contents]

Canada Communicable Disease Report - Supplement
Volume: 23S8
December 1997

INFECTION CONTROL GUIDELINES

Foot Care by Health Care Providers

Sources and Reservoirs of Foot Infection

The microflora of the foot include organisms that are resident (those that normally inhabit the skin) and those that are transient (those that have been deposited on the skin).  People who have been cared for in health care institutions or who have damaged tissue have a greater risk of being colonized with organisms that are not normally found on the foot⁽¹³⁾. Approximately 50% of the population have athlete's foot infection some time in their life⁽¹⁴⁾.  Micro- organisms may be transmitted from person to person by direct contact, usually through the hands of health care providers^(13,15), or indirect contact (by a vehicle such as foot care equipment)⁽¹³⁾.  Sources of infection can be divided into the following two categories:

1. endogenous sources:  caused by flora or infection on the person's own body (e.g., Staphylococcus aureus from the nose or Corynebacterium minutissimum from the skin).

2. exogenous sources:  caused by infected or colonized people or animals and environmental sources (e.g., flora from others such as S. aureus or infections from animals such as Microsporum canis)⁽¹⁶⁾.

Viruses present in the blood of persons receiving foot care may also create a risk of infection for others.  Of greatest concern are the bloodborne pathogens hepatitis B virus (HBV), hepatitis C virus (HCV), and the human immunodeficiency virus (HIV)⁽¹⁶⁾.  Because sharp instruments used during foot care may puncture the skin and become contaminated with blood, they must be appropriately cleaned and sterilized between use.  Sterilization destroys all forms of microbial life.  Any microorganism that comes into contact with a mucous membrane, skin that is not intact, sterile tissue, or the vascular system has the potential to cause infection.  Instruments used in foot care that may break the skin must be sterile.

Foot Care Equipment

Foot care equipment is transported in the nurse's carrying bag to the foot care site.  The assembled foot care equipment should contain:

• a set of sterilized foot care instruments for each patient/client

• disposable paper towel on which to place instruments during procedure

• commercial puncture-proof sharps container

• skin antiseptic

• hand washing soap and disposable towels

• waterless hand washing agent

• container to transport used instruments

• one pair of non-sterile medical gloves (latex, vinyl, nitrile etc.) for each patient/client

• foot emollient (lotion or cream)

• protective equipment (eye shield, disposable face mask and disposable apron, gown or towel)

• sterile gauze or Band-Aid^®

Cleaning Foot Care Equipment

All items should be washed in warm water with a detergent. Personnel who are cleaning the equipment should wear general purpose household gloves.  Files and hinged instruments should be cleaned with a small brush (e.g. toothbrush) while the instrument is held under water to prevent splashing.  An ultrasonic cleaning device may be used as an additional step in the cleaning process.  Washed items should be left to dry.  Cleaned instruments should be placed in packaged sets prior to sterilization.

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