Is an autoclave necessary?

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I have seen a large spectrum of disinfection methods in my short podiatry life. From an office that reused scalpels if no blood was drawn to an office that used an autoclave for every single use of nail nippers.

Is cold sterilization enough for nail nippers or do I need to buy 40 for daily use?

 

[PeaJay]

Every instrument that is utilized should be autoclaved/peel packed.

If a barber sterilizes the combs in a fancy green juice that’s fine. Surgeons separated from barbers long ago.

There are many who can argue the science of sterilization, however i would recommend running if your doctor is pulling their instruments from a dish.

 

[heybrother]

If you haven't done it before you should search for variations of sterilization + medical offices etc. There's a lot out there.

Example: https://www.cdc.gov/infectioncontrol/pdf/Podiatry-Guide_508.pdf

 

[Feli]

Yes.

 

[DYK343]

The sterile bath is always so wrong. I distinctly remember my student rotations in school and a LOT of doctors had a #15 blade on the handle reused over and over in that mystery bath.

Absolute no way thats sterile.

I wouldnt let anyone touch me with a medical instrument unless its been autoclaved.

que @ExperiencedDPM ...

 

[PTPuser]

That bath is so nasty.

 

[Pronation]

Just wipe the thing on your pant leg and throw it back in the drawer. What's the big deal?

 

[deleted285117]

Autoclaving is overrated... use this instead:

 

[DYK343]

Just wipe the thing on your pant leg and throw it back in the drawer. What's the big deal?

Pretty sure thats how its done in nursing homes. Only its directly onto the next.

 

[PMG03470]

Pretty sure thats how its done in nursing homes. Only its directly onto the next.

Yup, I can confirm this… my first crappy PP job had me in nursing homes 50 hours a month and all I was sent with was 1 pair of nippers, a box of alcohol swabs, and a single Dremel head for typically 40-50 patients in a day no assistant or anything else… even better was the only thing I had to prop their feet up on was an old cat tree donated by a previous patient, otherwise I would have been on the floor doing it

 

[DYK343]

Yup, I can confirm this… my first crappy PP job had me in nursing homes 50 hours a month and all I was sent with was 1 pair of nippers, a box of alcohol swabs, and a single Dremel head for typically 40-50 patients in a day no assistant or anything else… even better was the only thing I had to prop their feet up on was an old cat tree donated by a previous patient, otherwise I would have been on the floor doing it

 

[wakaflocka88]

Yup, I can confirm this… my first crappy PP job had me in nursing homes 50 hours a month and all I was sent with was 1 pair of nippers, a box of alcohol swabs, and a single Dremel head for typically 40-50 patients in a day no assistant or anything else… even better was the only thing I had to prop their feet up on was an old cat tree donated by a previous patient, otherwise I would have been on the floor doing it

Sorry to hear. How much did you get paid for seeing 50 crumbles?

 

[deleted285117]

Yup, I can confirm this… my first crappy PP job had me in nursing homes 50 hours a month and all I was sent with was 1 pair of nippers, a box of alcohol swabs, and a single Dremel head for typically 40-50 patients in a day no assistant or anything else… even better was the only thing I had to prop their feet up on was an old cat tree donated by a previous patient, otherwise I would have been on the floor doing it

Hero of Podiatry.

 

[DYK343]

Hero of Podiatry.

Saving lives
(...Or spreading Hep C)

 

[icebreaker32]

Yup, I can confirm this… my first crappy PP job had me in nursing homes 50 hours a month and all I was sent with was 1 pair of nippers, a box of alcohol swabs, and a single Dremel head for typically 40-50 patients in a day no assistant or anything else… even better was the only thing I had to prop their feet up on was an old cat tree donated by a previous patient, otherwise I would have been on the floor doing it

Imagine if the colleges/APMA used this story for recruiting to accurately describe the profession.

This profession has many career paths: some of you might be foot surgeons and many others will sit on the floor in nursing homes trimming toenails using unsanitary instruments.

 

[diabeticfootdr]

Just get single-use, disposable instruments. They end up being cheaper (than autoclaving) and sharper than reusable. We get nail nippers for ~$5, debridement kits for ~$10, and P&A kits for ~$15.

 

[icebreaker32]

For academic and institutional settings it makes a lot of sense.

At a nursing home nails pay next to nothing, maybe $25 each for 30-50 patients. So this would actually serve to basically significantly lower the already low reimbursements. I have no idea, but I doubt any of the larger companies in our profession with this business model are using disposable nippers for this reason.

Nursing home work is usually a high volume and low overhead situation for it to make any sense. Even then it usually offers a poor ROI. That is why it realistically needs to go away, If one wants to practice like a typical doctor……sterile separate instruments or disposable instruments, bringing an assistant with them while performing services that actually pay enough to make a reasonable living. As long as there are podiatrists doing this type work in nursing homes, which really makes no sense as per a ROI then saturation not only exists, but is very high in this profession.

That is why most podiatrists and most companies would rather see patients at their homes and assisted living centers. Despite the lower volume they can offer other services like vascular testing, ultrasound testing and braces etc. Now if most of those patients really need those extra services is another discussion.

 

[Pronation]

Why are we even discussing nursing homes? This is pure garbage work.

 

[icebreaker32]

Why are we even discussing nursing homes? This is pure garbage work.

Because Podiatry

It always comes back to toenails

 

[DYK343]

Just get single-use, disposable instruments. They end up being cheaper (than autoclaving) and sharper than reusable. We get nail nippers for ~$5, debridement kits for ~$10, and P&A kits for ~$15.

Sounds so wasteful though.

 

[Jummy Biffett]

Just get single-use, disposable instruments. They end up being cheaper (than autoclaving) and sharper than reusable. We get nail nippers for ~$5, debridement kits for ~$10, and P&A kits for ~$15.

Where are you sourcing from? Prices I've come across run much more than $5..

 

[BubbaWub]

Some of my most profitable days are spent at the nursing homes. I can crank out usually 50-60 patients a day, each paying $20 per patient. I would say it is my best grossing days of the month. We should embrace these positions, because they will become more profitable as time goes on. Along with this, it is a needed service.

 

[deleted285117]

Some of my most profitable days are spent at the nursing homes. I can crank out usually 50-60 patients a day, each paying $20 per patient. I would say it is my best grossing days of the month. We should embrace these positions, because they will become more profitable as time goes on. Along with this, it is a needed service.

 

[Pronation]

I can crank out usually 50-60 patients a day, each paying $20 per patient.

Will all due disrespect, sir, unless a working day for you consists of working 8a-12p, that compensation is hot garbage. Particularly for the backbreaking, carpal tunnel inducing, and stale piss stench infested work involved.

 

[wakaflocka88]

Some of my most profitable days are spent at the nursing homes. I can crank out usually 50-60 patients a day, each paying $20 per patient. I would say it is my best grossing days of the month. We should embrace these positions, because they will become more profitable as time goes on. Along with this, it is a needed service.

99% sure you are trolling, sir.

If not please share this opportunity for the new fellowship trained grads looking for work.

 

[Drjc1977]

I have seen a large spectrum of disinfection methods in my short podiatry life. From an office that reused scalpels if no blood was drawn to an office that used an autoclave for every single use of nail nippers.

Is cold sterilization enough for nail nippers or do I need to buy 40 for daily use?

Just wipe what ever you use off with a paper towel. When the towel gets ditty, just get a new one. This can't be a serious question, can it?

 

[BubbaWub]

99% sure you are trolling, sir.

If not please share this opportunity for the new fellowship trained grads looking for work.

We all have to make a living somehow. This is a large portion of my practice. I do believe that most fellowship trained graduates would not be able to perform this job due to not building up proficiency/efficiency. I have a fellowship trained graduate in my clinic, and he does not spend very much time trimming nails, where usually I will spend at least 5-10 minutes performing debridement and utilizing a dremel to smooth out the edges. I have had some referrals sent to me specifically for this pathology due to how well I perform these procedures.

 

[HardRoadPaved]

Just wipe what ever you use off with a paper towel. When the towel gets ditty, just get a new one. This can't be a serious question, can it?

ah the good ole spit and shine....

 

[deleted285117]

We all have to make a living somehow. This is a large portion of my practice. I do believe that most fellowship trained graduates would not be able to perform this job due to not building up proficiency/efficiency. I have a fellowship trained graduate in my clinic, and he does not spend very much time trimming nails, where usually I will spend at least 5-10 minutes performing debridement and utilizing a dremel to smooth out the edges. I have had some referrals sent to me specifically for this pathology due to how well I perform these procedures.

Better show that fellow what’s what bro!

 

[icebreaker32]

Is it theoretically possible to do OK with nursing homes, I suppose.

Unfortunately this assumes a lot of things.

You have no office overhead

You have no surgical malpractice

You bring no staff to assist

You do not use disposable instruments

You have facilities with helpful staff to assist with patient care and paperwork required for billing

Other things to consider

To have enough facilities to make a career of it you will often need to drive far.

Then there is often politics to keep facilities as those in charge sometimes think you have a goldmine and want something in return.

You also risk eventually getting an audit that causes disruption of cash flow or results in paybacks. If this happens it will be extra stressful with almost all of your income coming from Medicare. You risk much worse and will likely eventually get caught if coding for nail avulsions and patients you never saw.

Then as mention the toll it can take on one's body.

If one picked up a couple facilities when they started out and kept them because they are very close and well run, then going a day or two a month might be productive enough days to justify.

Some can practice lobster podiatry and make it work. Good for them, if it is better than their other options. It is still a real bad sign for our profession that we are still doing this.

The best use of nursing homes is temporary lobster podiatry as we have few options for moonlighting is a side hustle while saving to open a practice or during the very early years of opening a practice if necessary.

 

[diabeticfootdr]

Where are you sourcing from? Prices I've come across run much more than $5..

Sterile Solutions. They are UK based, but have a U.S. distributor. DM me if you want me to look for their contact.

 

[diabeticfootdr]

For academic and institutional settings it makes a lot of sense.

At a nursing home nails pay next to nothing, maybe $25 each for 30-50 patients. So this would actually serve to basically significantly lower the already low reimbursements. I have no idea, but I doubt any of the larger companies in our profession with this business model are using disposable nippers for this reason.

Nursing home work is usually a high volume and low overhead situation for it to make any sense. Even then it usually offers a poor ROI. That is why it realistically needs to go away, If one wants to practice like a typical doctor……sterile separate instruments or disposable instruments, bringing an assistant with them while performing services that actually pay enough to make a reasonable living. As long as there are podiatrists doing this type work in nursing homes, which really makes no sense as per a ROI then saturation not only exists, but is very high in this profession.

That is why most podiatrists and most companies would rather see patients at their homes and assisted living centers. Despite the lower volume they can offer other services like vascular testing, ultrasound testing and braces etc. Now if most of those patients really need those extra services is another discussion.

Actually for disposable instruments, the SNF should buy them.

 

[icebreaker32]

Actually for disposable instruments, the SNF should buy them.

Yes the lower pay in facilities versus an office is due largely to them providing your supplies (in theory) and overhead for patient care.

In reality getting a facility to order disposable nippers that has never had to may not be easy unless they really, really want a podiatrist and don't have one.

Now on the other hand if the facilities go for it you have another potential job opportunity.....become a disposable nail nipper salesman selling to nursing homes.

 

[Adam Smasher]

We all have to make a living somehow. This is a large portion of my practice. I do believe that most fellowship trained graduates would not be able to perform this job due to not building up proficiency/efficiency. I have a fellowship trained graduate in my clinic, and he does not spend very much time trimming nails, where usually I will spend at least 5-10 minutes performing debridement and utilizing a dremel to smooth out the edges. I have had some referrals sent to me specifically for this pathology due to how well I perform these procedures.

@icebreaker32 beat me to this. I'm not sure how much attention you've paid but this is where the lobster comparisons come from. On the one hand, this is consistent work that will never go away and will guarantee your long term survival, just like how lobsters outlived the dinosaurs. On the other hand, it's something ANYONE can do, and the only reason we do it and you they don't is because they have better ways to earn a living and WE don't. We scavenge what falls to the bottom, like lobsters.

 

[Boba Foot]

Just get single-use, disposable instruments. They end up being cheaper (than autoclaving) and sharper than reusable. We get nail nippers for ~$5, debridement kits for ~$10, and P&A kits for ~$15.

That’s so wasteful, my brother in toenails.

 

[DYK343]

60 patients x $20 average reimbursement is $1200 a day x 5 days a week x 12 months (no vacation) is 288k yearly.
Seeing 60 nail care patients a day in a nursing home
My god. No thanks.

Doesnt include calluses, E&Ms, etc. But still. I just couldnt do it.

 

[deleted285117]

60 patients x $20 average reimbursement is $1200 a day x 5 days a week x 12 months (no vacation) is 288k yearly.
Seeing 60 nail care patients a day in a nursing home
My god. No thanks.

Doesnt include calluses, E&Ms, etc. But still. I just couldnt do it.

 

[diabeticfootdr]

That’s so wasteful, my brother in toenails.

Perhaps, but it is an infection prevention standard in many US institutions and certainly in Europe.

 

[DYK343]

Perhaps, but it is an infection prevention standard in many US institutions and certainly in Europe.

Autoclaving is pretty sterile..

 

[Adam Smasher]

First world problems: it's cheaper to throw away nail nippers than to pay an assistant to peel-pack and autoclave them

Edit: this should have been a meme, damn

 

[GreenHousePub]

That fellow is busy doing recon and spending

60 patients x $20 average reimbursement is $1200 a day x 5 days a week x 12 months (no vacation) is 288k yearly.
Seeing 60 nail care patients a day in a nursing home
My god. No thanks.

Doesnt include calluses, E&Ms, etc. But still. I just couldnt do it.

Just don't the nursing home then. 30 patients x $50 dollars reimbursement x 5 days x 12 months no vacation is over 300k yearly.

That doesn't include calluses, E&Ms and others too.

 

[DYK343]

That fellow is busy doing recon and spending


Just don't the nursing home then. 30 patients x $50 dollars reimbursement x 5 days x 12 months no vacation is over 300k yearly.

That doesn't include calluses, E&Ms and others too.

30 patients x $80 average reimbursement in my clinic x 5 days x 12 months is $576,000

Not including surgery patients or inpatient consults.

No thanks to nursing homes. And good luck finding a nursing home 5 days a week every week of the year.

 

[Pronation]

I would go back and become a plumber or electrician before stepping foot into some nasty piss infested nursing home to clip toenails on demented patients all day. Revolting.

 

[Creflo]

To the OP, I have an autoclave and use it for my nippers. But let's be honest as trained scientists. We all know that if the goal here is sterility, as in surgical sterility, you not only need an autoclaved instrument, but you also need a prepped skin/toenail surface. How many of the autoclave for nail gurus are doing this? After cutting that first toenail on the old guy who can't reach his nails and hasn't washed his feet in a month, you know the one when you pull his socks off white stuff flies everywhere, how sterile do you think your nipper is on nails 2-10? Truth is a lot of pods are not using autoclaved instruments on nails, especially after the first nail.

 

[PeaJay]

To the OP, I have an autoclave and use it for my nippers. But let's be honest as trained scientists. We all know that if the goal here is sterility, as in surgical sterility, you not only need an autoclaved instrument, but you also need a prepped skin/toenail surface. How many of the autoclave for nail gurus are doing this? After cutting that first toenail on the old guy who can't reach his nails and hasn't washed his feet in a month, you know the one when you pull his socks off white stuff flies everywhere, how sterile do you think your nipper is on nails 2-10? Truth is a lot of pods are not using autoclaved instruments on nails, especially after the first nail.

Huh? In this case the sterilization is to prevent the spread of blood borne pathogens (from previous patient). Not to protect nail number one from nail number two.

 

[Pronation]

You guys don’t pull out 10 fresh nail nippers for everyone coming in for their medical grade pedicure?

 

[DYK343]

The sock shake out
The damn sock shake out with skin cells flying everywhere.
Why do they always do it?
I straight up leave the room for 5 minutes when they do it and go onto the next one.

 

[Pronation]

The sock shake out
The damn sock shake out with skin cells flying everywhere.
Why do they always do it?
I straight up leave the room for 5 minutes when they do it and go onto the next one.

As a total toenail replacement surgeon, I keep my clinic running smoothly by requiring all patients to have both socks and rotten bedroom loafers off before I enter the room. If I open the door and they have their socks still on then I’ll immediately make a U turn at the door and let them know they can have a few minutes to get situated with their socks off. I will then go see another patient entirely.

 

[Adam Smasher]

Should we be trimming the nondystrophic nails first to avoid cross contamination with the mycotic nails, instead of going straight down the line?

God, I remember I used to ponder things like morality, life after death, the meaning of life. Now I think about this. Sometimes I hate what podiatry has done to me.

 

[deleted1162946]

Nails are disgusting