Podiatrists specialise in the treatment of feet. As part of their repertoire, they treat a wide range of foot related issues, from sport injuries and slips, to on-going issues such as diabetic ulcers, gangrene and toenail infections.
A common task for podiatrists is the reducing of calluses/corns/nails/skin through drilling, chemicals and cutting – all of which can cause microbial dust and/or hazardous chemicals to be distributed into the air.
While podiatrists are perhaps most at risk due to their proximity, the force at which the microbial dust is dispersed has the potential to also cause risk for care assistants in the room and the patient themselves, unless properly controlled.
It is estimated that dust particles created when drilling toenails are on average between 0.8–1.6µm, with most matter being smaller than 5µm. Particles smaller than 5µm are known as ‘fine dust’ and, once inhaled, are highly susceptible to be deposited in your lungs and not exhaled again.
Within this dust are a series of hazardous microorganisms including Trichophyton Rubrum, Streptococcus Faecalis, Diphtheroid Bacilli, Dermatophytes, Aspergillus, Fusarium and Mucor among others. Due to the aerosolization of blood and body fluids, there is also a serious risk of hepatitis B and HIV containing molecules being spread into the atmosphere.
As a result, research suggests that podiatrists are four times more likely to develop asthma than the general population, indicating that the aforementioned dust is a respiratory sensitiser and can lead to occupational respiratory ill-health.
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.
 J G Burrow, N A McLarnon, Evidence based risk management of nail dust in chiropodists and podiatrists, Occup Eniron Med, 2006 [accessed 19/06/2019] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078045/
 Millar N A. The ocular risks of human nail dust in podiatry. PhD Thesis, Glasgow Caledonian University 2000 https://www.researchgate.net/publication/34503834_The_ocular_risks_of_human_nail_dust_in_podiatry
 Paul D Tinley, et al, Contaminants in human nail dust, J Foot Ankle Res, 2014 [accessed 19/06/2019] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3937521/