Nail Care

Routine nail care refers to basic grooming and hygiene activities involving fingernails and toenails. It is non-invasive and intended for healthy nails and skin.

Examples include:

• Nail trimming, filing, buffing, or shaping.
• Cleaning under nails.
• Pushing back, softening, or cutting cuticles.
• Giving hand or foot scrubs/massages.
• Applying moisturizers/lotions to hands and feet.
• Applying or removing nail polish, including gel, acrylic, or shellac.
• Using pumice sticks to remove calluses.
• Simple manicure or pedicure.

Although considered low risk when properly performed, routine nail care may increase the risk of:

• Skin breaks, cuts, or bleeding.
• Fungal or bacterial infections.
• Microorganisms spreading through dirty equipment, surfaces, or poor hand hygiene.
• Injury to residents with diabetes, peripheral vascular disease, neuropathy, anticoagulant therapy, or existing damaged or broken skin.

In LTCHs, RHs, and other congregate living settings, routine nail care can be provided to residents with healthy nails and skin by unregulated staff (i.e., personal support workers), regulated staff (i.e., registered nurse, registered practical nurse), caregivers. Residents may perform their own routine nail care, if able.

Residents with complex medical conditions or abnormal foot/nail conditions should receive nail care from a trained healthcare professional.

Advanced foot care involves assessment and treatment of higher-risk foot and nail conditions and is typically provided by qualified healthcare professionals.

Advanced foot care may include:

• Management of thickened or fungal nails.
• Reduction of corns and calluses.
• Care of diabetic feet.
• Assessment of circulation and skin integrity.
• Treatment of ingrown toenails.
• Foot ulcer prevention and monitoring.

Advanced foot care may involve invasive procedures and increased risk of exposure to blood or body fluids.

Risks to residents receiving advanced foot care include:

• Skin breaks, cuts, or bleeding.
• Fungal or bacterial infections.
• Microorganisms spreading through dirty equipment, surfaces, or poor hand hygiene.
• Injury to residents with diabetes, peripheral vascular disease, neuropathy, anticoagulant therapy, or existing damaged or broken skin.

Appropriate infection prevention and control measures and professional standards must be followed.

In LTCHs, RHs, and other congregate living settings, advanced foot care can be provided to residents by qualified healthcare professionals, including:

• Registered Nurses with specialized foot care training.
• Nurse Practitioners.
• Chiropodists.
• Podiatrists.

Residents expect and require safe care regardless of where nail care is performed. Health care associated infections and outbreaks have been linked with improper footcare practices and inadequate reprocessing (cleaning, disinfection, and sterilization) of re-usable foot care devices.

LTCHs, RHs, and other congregate living settings that bring in third-party advanced foot care professionals should verify:

• The professional has written policies and procedures for every nursing skill and administrative process for the services they provide.
• The professional has written policies and procedures clearly outlining the steps for cleaning, disinfection and sterilization of re-usable equipment, if they are reprocessing the re-usable equipment themselves. Alternatively, the professional has contracted services of a centralized Medical Device Reprocessing Department (MDRD) to reprocess the re-usable equipment.
• The professional has IPAC education and training on the consistent use of Routine Practices, including performing hand hygiene as per Public Health Ontario's Four Moments of Hand Hygiene and conducting a Personal Risk Assessment, to prevent exposure to blood and body fluids while providing advanced foot care.
• The professional consistently performs hand hygiene before providing advanced foot care and wears appropriate personal protective equipment (PPE). Hand hygiene must be performed at the appropriate moments when donning and doffing PPE, as well as between residents.
• The professional uses a sterile set of critical foot care equipment for each resident.
• The professional maintains clean and sterile supplies in a closed container, shelf or drawer, away from the floor, waste, debris, drains, moisture, and sinks to prevent contamination and sterility is maintained until the time of use.
• Equipment such as emery boards, orange sticks, podiatry (rotary) tool/device discs, are considered single-use items and shall be discarded after use. A new one must be used each time care when providing advanced foot care to a resident.
• Foot baths or basins used to clean the feet are lined with a single-use plastic liner that is discarded after each use. The basin is cleaned and disinfected as per the manufacturer's instructions after each use.
• Multi-dose antiseptics, medications, creams, lotions, should be dedicated for single resident use. If single use is not available, dispensed in a manner that prevents contamination of the product, such as using an applicator (sterile if indicated) or medicine cup to dispense from the multi-use product to prevent contamination.
• Sharps, such as scalpel blades or callus pare blades, are single-use, sterile and disposed of in a puncture-resistant biohazard container after use.

Advanced foot care devices, equipment and supplies must remain in packages and only be opened just before starting services. A sterile set of critical foot care equipment/devices is required for each resident interaction. The package should always be inspected before use. If the package is open, damaged or wet, the equipment/devices can no longer be considered sterile, and they must not be used.

Sterile packs, instruments, and supplies must be stored in a clean, dry, dust free area and not be stored in the resident care area. If providing advanced footcare to a resident within their own room, only necessary instruments, devices, equipment and supplies should be brought into the room.

It is acceptable to use a hard carrying case that can easily be cleaned and disinfected between residents to store all advanced foot care devices, equipment and supplies. A separate covered, puncture-resistant container is required to collect soiled re-usable instruments, devices, equipment.

Supplies such as emery boards, orange sticks, podiatry (rotary) tool/device discs, and blades are single-use, and must be discarded appropriately after use. See the Waste section below for additional information.

Immediately after providing care for each resident, non-critical equipment/devices, furniture and work surface areas must be cleaned and disinfected. This includes all surfaces touched during care, for example chairs, tables, exam tables, foot stools, and toolboxes or carts.

Cleaning removes dust, soil, organic material (e.g., blood, secretions, excretions, and microorganisms) from a surface or object. Cleaning physically removes rather than kills microorganisms using water, detergents and friction.

Disinfection is the process of eliminating or killing most microorganisms on objects and surfaces using a healthcare grade disinfectant. Before disinfection can be effective, surfaces and objects must be thoroughly cleaned.

Products used for cleaning and disinfection require a drug identification number (DIN) from Health Canada and the manufacturer's instructions for use (MIFUs) for concentration and contact time must be followed.

Contact time is the time that a disinfectant must be in contact with a surface or device to ensure appropriate disinfection has occurred. For most disinfectants, the surface should remain wet for the required contact time.

Waste that is generated during advanced footcare, including but not limited to nail clippings, paper covers, blue pads, and non-sharps waste must be discarded in appropriate waste containers at the point-of-care.

Sharps, such as scalpel blades or callus pare blades, are single-use and must be discarded safely after use. A puncture-resistant biohazard container that meets provincial regulatory requirements must be available at the point-of-care.