The overall goal of infection prevention practices for foot care is to
eliminate the risk of the transmission of pathogens between clients and
between clients and the health care worker. Foot trauma during the
foot care procedure should be avoided to eliminate the client risk of
acquiring infections. The following recommendations should be implemented
when providing foot care.
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All foot care equipment for re-use must be capable of being cleaned
in a detergent and water to remove organic matter.
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Single-use items such as emery boards, orange sticks and rotary tool
disks should be discarded after use. If a client's own
equipment is used, it must be kept clean and dry.
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All instruments used in foot care must be sterile before use
on a client/patient. Instruments that must be sterilized prior
to use, often packaged in sets, may include the following: nail nippers
foot dresser file Black's file rasp scalpel handle (for attachment
of blade) nail probe callus parer
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The recommended methods of sterilization for foot care instruments
include dry heat; autoclave (steam under pressure); or chemisterilant
with exposure time as stated on product's label. Methods of
cleaning, disinfection and sterilization are detailed in text and
tabular form in the Health Canada publication Infection Control
Guidelines for Cleaning, Disinfection, Sterilization and Antisepsis
in Health Care(17).
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Glass bead sterilization is not an effective method of sterilization
and should not be used(17-19).
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Boiling water(20) and microwave ovens are not effective
methods of sterilization and should not be used(17).
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Hand washing is the single most important procedure for preventing
infections(17). Hands must be washed with soap and
water before beginning the foot care procedure. Hands should
be washed before glove use and after glove removal. Foot care
clinics should be arranged with consideration for the availability
of hand washing sinks. Waterless hand washing agents may be
used if a sink is not available(17).
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Non-sterile medical gloves should be worn throughout the procedure
to prevent exposure to bacteria, fungi and viruses(21).
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Gloves must be changed for each patient. The hands should not
be washed with gloves on.
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Eye shields or glasses should be worn to protect the health care
provider from nail clippings or debris(17,21).
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A disposable face mask should be worn to reduce the possibility of
inhaling organisms that may be aerosolized during filing of nails.
The inhalation of nail dust has been associated with conditions
such as conjunctivitis, rhinitis, and an occupational lung disease
called "podiatrist's lung"(22-24). Masks should fit snugly
and be worn for one patient/client only.
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If the foot of the person receiving care is positioned on the lap
of the health care provider, the clothing of the health care provider
should be protected by a disposable gown, apron, or a clean towel.
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The use of a foot soak prior to foot care is controversial(25);
however, the feet should be clean. Feet should be washed
with a mild soap and warm water. If the foot basin is used it
should be washed with soap and water, rinsed, and dried thoroughly
between clients.
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A skin antiseptic should be used to wipe areas of the feet that will
be touched by a foot care instrument (e.g., before removing calluses).
If cotton balls are used, a disposable container should be used
to wet the cotton balls with the antiseptic. Alternatively,
prepackaged swabs should be used.
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Emollients, such as lotions/creams, are often used to massage and
moisturize the foot(26). It is desirable to use small,
single use lotion bottles that can be left with the client(17).
If the bottle containing the lotion is used on more than
one client, care must be taken to keep the contents free from contaminants.
Squeeze the lotion onto the gloved hand without touching the
bottle opening.
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If towels are used during foot care clinics, the towel should be
used for one client only. Clients should not walk with bare
feet. Plantar warts are more frequently associated with users
of public showers, sports centres, and gymnasia(27,28).
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If the integrity of the skin is accidentally breached, the area should
be wiped with a skin antiseptic and covered with a loosely applied
sterile gauze or a Band-Aid®. Constrictive adhesive
dressings should not be applied to toes(29). A protocol
should be developed for the daily monitoring and documenting of the
wound healing process.
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If used, blades on foot care instruments should be disposed of in
appropriate sharps containers at the completion of each foot care
treatment. Blades must not be re-used.
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All health care workers providing foot care should be aware of protocols
for the prevention of the transmission of bloodborne pathogens, e.g.,
recommendations for hepatitis B immunization and management of accidental
exposure to blood(30-32).
