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Toenail Kit Cleaning

Q: I work for a Podiatrist. We keep a "toenail kit" in a cleaning solution in every exam room. After clipping nails or scraping dead skin away, the instruments are put back in this solution until the next patient. NO CLEANING IS PERFORMED between patients or at the end of the day. The solution is replaced every morning. Is this okay?

A: An important part of determining if this practice is acceptable depends on the class of instrument (i.e. critical, semi-critical, non-critical) these kits are and what level of decontamination the "cleaning solution" provides.

It sounds, if they are just used for nail and intact skin, they are of the non-critical class. Non-critical instruments, which include stethoscopes and blood pressure cuffs, should be wiped down with alcohol, an iodophor or a phenolic (i.e. Lysol, Amphol) between patient use.

The concern would be if during use the kit was used to cut (likely accidentally) beyond the dead portion and consequently was contaminated with patient blood. If contaminated with blood the toenail kit would need to be disinfected before the next patient contact.

I would recommend trying to find out what the "cleaning solution" they are soaking in actually is and go from there. Please let me know what you find out.

For more information on instrument classes and decontamination procedures, check out Tab 8 of the Quality America OSHA Safety Program Manual. I hope this helps!


Posted by Quality America on June 14, 2007 | Comments (2)

Comments

Benzall is the name is of the "cleaner" used for the toenail kit. There are times when there might be a little blood on the instruments and they are still placed in this solution until the end of the day, then the solution is changed and instruments are rinsed off and they start over.

Posted by: Kathy at July 9, 2007 02:17 PM

Sounds like, based upon blood occasionally getting on these instruments, that they aren't getting the decontamination treatment that's needed.

I can't find Benz-all as an EPA registered disinfectant on the EPA's website. I've checked lists A-F here: http://www.epa.gov/oppad001/chemregindex.htm

Also, no where on the Benz-all product page, http://www.xttrium.com/product_details.aspx?ProductID=17 do they claim the product is EPA registered.

Based on this, I conclude that the Benz-all is definitely inadequate for decontaminating items with blood contact. I'd recommend discontinuing its use in favor of another, EPA registered, product or an autoclave.

To comply, you will need to bring in an autoclave or EPA approved high-level disinfectant (glutaraldehyde, OPA) to decontaminate toenail kits that have had contact with blood.* Also, it doesn't sound like there is any pre-scrubbing happening before decontamination/sterilization to remove bioburden. Pre-cleaning to remove the bioburden is absolutely needed for instrument decontamination to be successful.

*Of course this raises the question what about the kits that aren't visibly contaminated? I would recommend treating them the same way, nothing like making the headlines because your patient contracted HIV from an instrument you didn't clean because it wasn't visibly bloody...

Posted by: Sarah Alholm at July 9, 2007 03:25 PM




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