To prevent respiratory risk to those in the room, three controls can be introduced:
- Local exhaust ventilation (LEV)
- Respiratory protective equipment (RPE)
- Good hygiene
LOCAL EXHAUST VENTILATION
Nail drilling can be accompanied by local exhaust ventilation (LEV) to evacuate the nail dust away from the podiatrist. This is a good practice as it helps to control the risk of inhalation to both the doctor, their team and the patient.
LEV however can vary in effectiveness and requires regular maintenance and testing to ensure it remains efficient.
RESPIRATORY PROTECTIVE EQUIPMENT
A second means of respiratory protection podiatrists should employ is RPE (respiratory protective equipment). Suitable and adequate RPE should be worn to filter out any hazardous substances from entering the wearer’s lungs not caught by the LEV.
In the UK healthcare industry, P3 particulate single-use facepiece respirators are commonplace and would provide an adequate level of protection from the microbial matter contained in the nail dust.
A recent study asked podiatrists ‘what kind of RPE do you wear during nail reduction’. While 49% said that they regularly wore disposable respirators, 28% stated that they wore a surgical mask when operating and 17% declaring that they wore no mask of any kind.
Unlike surgical masks, single-use RPE relies on a seal being formed around the user’s face to ensure no contaminated air can pass through the gaps – providing much better protection to its wearer.
To ensure tight-fitting RPE is effective, the wearer must first undertake a face fit test to ensure compatibility with the chosen respirator. Successfully passing a fit test indicates that a particular make/model of tight-fitting RPE is able to achieve a suitable seal around the user’s face and that the respirator will provide the expected level of protection when worn. Face fit testing is a legal requirement under COSSH.
Of those questioned in Tinley’s study, only 40% admitted to changing their respirator after each patient.4
Even if RPE and LEV is used, some nail dust will remain in the immediate atmosphere, on the drill, the podiatrist’s hands and on the respirator. Unless regular decontamination of devices and changing of gloves/masks is practiced particles can be spread from surface to surface causing risk of cross contamination and infection.