APMA News - April 2012 - (Page 36)

Infection Control Issues in the Podiatric Setting T BY ALAN J. SNYDER, DPM; MOON KIM, MD, MPH; CLARA TYSON, RN, MSN; AND LAURENE MASCOLA, MD, MPH chair, floors) were not cleaned or disinfected between patients; and reprocessing and disinfection of contaminated instruments: practitioners did not clean contaminated instruments with detergent and brushes prior to soaking them in disinfectant; instruments were not rinsed, dried, and put in clean containers before being reused on patients; instruments were not sterilized. he Acute Communicable Disease Control Program at the Los Angeles County (LAC) Department of Public Health has conducted investigations of acute hepatitis B virus (HBV) outbreaks in LAC. Investigators uncovered breaches in infection control during podiatric procedures (e.g., nail clipping, callus shaving, wound debridement) and other procedures that could lead to transmission of HBV. One recent publication details an acute HBV outbreak related to podiatric practices1 at a long-term psychiatric facility. These breaches offer important lessons for podiatric physicians about our role in preventing the spread of communicable disease. Many health-care professionals may not be aware that HBV is resistant to drying, simple detergents, and alcohol, and it has been found to survive at room temperatures for seven days.2 HBV at concentrations of 102–3 virions/mL can be present on environmental surfaces in the absence of any visible blood and still cause transmission.3 Because infected patients can have high concentrations of HBV in blood or body fluids, and HBV is stable at ambient temperatures, transmission of HBV can occur in health-care settings through unapparent modes, such as exposure to contaminated environmental surfaces or equipment that has been inadequately disinfected or through exposures of nonintact skin (e.g., skin that is chapped or abraded).4, 5, 6 In addition, podiatrists who perform procedures outside their usual office setting (e.g., assisted living facility or longterm care facility) may not have their usual workspace to adhere to good infection control practices, thereby increasing their potential risk of transmitting bloodborne infections, such as HBV. Examples observed during recent outbreak investigations that could have resulted in contamination of equipment and surfaces with infected blood included: separation of contaminated equipment: non-disposable, used podiatry equipment (e.g., clippers) were visibly contaminated with blood but placed next to clean equipment; environmental disinfection between patients: after nail trimming, callus shaving, or other treatments were performed, visibly soiled areas (e.g., counters, • • • Because podiatric equipment used for nail/cuticle cutting and debridement may inadvertently penetrate the skin and come into contact with blood and may contaminate instruments even in the absence of visible blood, we urge podiatrists to take strict measures to properly clean and disinfect/sterilize equipment that is reused on patients. The Centers for Disease Control and Prevention (CDC) guidelines for preventing transmission of infectious agents in the health-care setting7 do not specifically address the spectrum of infection control issues faced by practicing podiatrists. APMA has adopted a policy titled Disinfection and Sterilization Guideline Recommendations for Podiatric Physicians, available at www.apma.org/DisinfectionGuideline. Because we have witnessed situations of HBV transmission in the podiatric setting, the LAC Acute Communicable Disease Control Program suggests that to reduce the risk of transmission, podiatric instruments capable of penetrating the skin, such as nail clippers, scalpels, files, and burrs, be considered critical instruments (equipment that enters, or is capable of entering, tissue that would be sterile under normal circumstances or the vascular system) that should be sterilized before being reused on another patient. [Editor’s Note: The APMA Disinfection and Sterilization Guideline Recommendations, created in consultation with the CDC, designate these tools as semicritical instruments.] At a minimum, podiatrists should perform all necessary steps in cleaning and appropriate high-level disinfection according to the manufacturer’s instructions; however, sterilization would be the gold standard to guarantee against transmission of HBV. n 1 Wise ME, Marquez P, Sharapov U, et al. Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility. 2011 Am J of Infect Control Aug: 1-7. 2 Favero MS, Bolyard EA. Microbiologic considerations: disinfection and sterilization strategies and the potential for airborne transmission of bloodborne pathogens. Surg Clin North Am 1995; 75:1071–89. 3 Advisory Committee on Immunization Practices (ACIP). A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States MMWR Recomm Rep 2005; 54; 1-23. 4 US Public Health Service. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001; 50:1–52. 5 Chiarello LA. Prevention of patient-to-patient transmission of bloodborne viruses. Semin Infect Control 2001; 1:44–8 6 Williams IT, Perz JF, Bell BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis 2004;38(11);1592-8 7 Healthcare Infection Control Practices Advisory Committee (HICPAC), CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008, www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf 36 APMA News April 2012 http://www.apma.org/files/secure/index.cfm?FileID=8777 http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf

Table of Contents for the Digital Edition of APMA News - April 2012

APMA News - April 2012
In This Issue
Contents
Gen Z and myFEET
Dr. Caporusso’s Inaugural Speech to the House of Delegates
The Nuts and Bolts of Your House
Residency Genesis: A Priority for the Profession
Forum Builds Profession-wide Consensus on Student Recruitment
APMA By the Decade: 1942–1951
Profiles in Progress: Postgraduate Education
2011 Podiatric Practice Survey: Insurance Plan Participation
Infection Control Issues in the Podiatric Setting
Committee Member Acknowledgements
Federal Advocacy Forum
APMAPAC Chair Report
IT Consultant
Visit the Nation’s Capital for The National
Annual Scientific Meeting Preliminary Program
Annual Scientific Meeting Registration Form
Annual Scientific Meeting Sponsors
Website Wisdom
Technofile
Small Business 101
APMA All Stars
In Short
Worthy of Note
Affiliates Corner
List of Affiliated Organizations
Insurance Advisor
New Members
Death Notices
APMAPAC Update
Development Update
Awards Nominations
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
Your APMA

APMA News - April 2012