When working as a foot care nurse you can expose yourself to many different environments. It is important to always protect yourself, which in turn protects the client and future clients you will see. As a foot care nurse, in independant practice, you can go from working in a long term care facility, to retirement home, to a private residence all within a couple of hours. When working for yourself, as an independant business and providing foot care, you must be knowledgeable of public health's policies and procedures, CNO's standards and Ontario's occupational health and safety standards, when it comes to client and visitor screening and assessment for infection control. You are your own boss, so you must protect yourself and take actions to ensure client protection.
All facilities (LTC, retirement homes, hospital, etc) have screening and health and safety practices in place as per public health and Occupational health and safety guidelines. When under the facilities roof, providing care to one of their residents/clients, as an independent practitioner, you are expected to follow and can make yourself aware of the facilities, infection control guidelines even through the facilities is not your employer. As an independant practitioner and foot care nurse, you must protect yourself and have your own policies for infection control and prevention, which follow the same guidelines (public health, occupational health and safety and CNO guidelines). See helpful links below.
If booking your own clients, ask the screening questions over the phone before seeing the client to ensure you are prepared for the situation and have correct PPE in place. As being a mobile service, ensuring you also follow the monthly inspection list for your mobile foot care tool bag, sterilization space and storage (aka clinical space). See below
Monthly Inspection Checklist for Clinical Office Safety
Visit all areas of the work place, looking for hazards that need correction, such as:
are sharps containers overfilled?
is PPE (gloves, masks, gowns) available and accessible?
is PPE in good condition?
are chemical disinfectants/sterilants labelled and stored properly?
are food preparation areas clean and dedicated for that purpose?
is there adequate ventilation if liquid disinfectants are used?
is storage shelving in good condition?
is there adequate liquid soap available at hand washing sinks?
is there alcohol-based hand rub at point-of-care?
is the protocol for disposal of hazardous waste being followed?
is the waste collection area clean and tidy, with waste covered?
are blood/body fluid spills cleaned by trained staff as they occur?
Booking, Reception and Placement
"Screening of Patients during Booking in all clinical offices should collect simple triaging information on the phone at the time of booking, if appropriate (e.g., same day or next day booking). Information collected should be based on symptoms of communicable disease or acute respiratory infection (ARI), such as cough, fever, vomiting or diarrhea. Additional screening, in keeping with the patient population, (e.g., chickenpox in pediatric populations, conjunctivitis in ophthalmology populations) may be added. Triage may also be augmented by specific conditions that may be prevalent in the community."
"Routine Practices are based on the premise that all patients are potentially infectious, even when asymptomatic, and that the same standards of practice must be used routinely with all patients to prevent exposure to blood, body fluids, secretions, excretions, mucous membranes, non-intact skin or soiled items and to prevent the spread of microorganisms. Adherence to Routine Practices protects not only the health care provider but also staff and patients who may subsequently be in contact with that health care provider. Elements of Routine Practices include:
Risk Assessment of the patient and the health care provider’s interaction with the patient
Hand Hygiene according to the “4 Moments” as described in Ontario’s Just Clean Your Hands Program
Control of the Environment, including appropriate accommodation, equipment reprocessing, environmental cleaning, safe handling of sharps and issues relating to construction and renovation
Administrative Controls (i.e., management of staff health and practices), including encouraging staff immunization, respiratory etiquette and audits of practice
Personal Protective Equipment (PPE) to protect staff (yourself)."
To read more see link below
Infection Prevention and Control for Clinical Office Practice
How to Put on PPE
Public Health Guidelines for Infection Control
College of Nurses Infection Control
"Shoes are very important for everyone but they’re especially critical for people with diabetes, to help them protect their feet and prevent injury, especially if they are experiencing loss of sensation (neuropathy). The right shoe and fit can help prevent the development of corns, calluses, blisters or wounds that can become infected and put the foot at risk of amputation." - Wounds Canada
Wounds Canada Link to foot wear brochure
American Based Educator Tools (Also helpful resources for clients)
Online Free Downloadable Magazine
Online interactive Maps
Self care Link
Online blood sugar conversion US (mg/dl) to Canadian (mmol/L)
• Pressure is a factor in 90% of diabetic plantar ulcers and the pressure must be modified or removed in order to heal the ulcers and prevent recurrence.
• Diabetic foot ulcer (DFU) recurrence is significantly reduced with professionally fitted footwear and insoles/orthoses.
• Three main factors contribute to elevated foot pressures that result in ulceration:
1. Intrinsic: neuropathy, altered blood flow, genetic or structural deformity
2. Extrinsic: shoes, ambulation and weight-bearing activity, traumatic accident or surgery
3. Behavioural: poor choice of footwear, lifestyle choices, type of ambulatory activity
• Offloading is the key to managing patients with a DFU and preventing further ulceration for the rest of the patient’s life. Clinicians should always remember that considerations when offloading the foot are not limited to the device itself, but also include patient characteristics, environmental factors, appropriate use of the device, modification of activity, reduction of walking speed and alteration of gait.
Link to Wounds Canada Product Picker Article
2018 WEBINAR SERIES
Portfolio Solutions in the
New Perspectives for the Holistic
Treatment of DFUs
Past Date but on demand viewing (July 31, 2018)
Treating patients with Diabetic Foot Ulcers (DFUs) is about more than just the wound. You're invited to join our featured faculty as they share insights on how they approach the holistic treatment of patients with DFUs. Learn about clinical challenges, patient journey considerations and how the ACELITY™ portfolio can help clinicians and patients at varying points of treatment.
The discussion will include a 40 minute presentation followed by Q&A.
Colin Traynor, DPM
Assistant Professor, The California School of Podiatric Medicine
Joyce N. Black
Ph.D., R.N., CPSN, CWCN, FAPWCA, MSN, BSN, DNS, FAAN
University of Nebraska Medical Center
To register click link below
I hope to see everyone there at the Niagara Health Expo
The 5th annual Niagara Health Expo, which will be held on Sat., Oct. 20, 2018, 10 am to 2 pm at the Hotel Dieu Shaver Health and Rehabilitation Centre in St. Catharines.
Please visit the link below. Yes it is an American based website but it has some informative information which can be applied to practice.
Sarah Lockbaum RPN, CDE, IIWCC
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