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Low-Level, Intermediate & High-Level Instrument Disinfection

Which Solution is Appropriate for my Foot Care Instrument Cleaning Needs?

Proper infection control is one of the most important aspects of foot care. While foot care practitioners generally don’t come into contact with blood, the risk of infection is just as great in a foot care clinic as it is in any other medical setting. This article contains information to help foot care nurses decide which disinfection solution is most appropriate for their practice.

When choosing a solution, there are only two things to consider:

1. Did your equipment solely come into contact with intact skin?

2. Did your equipment ever have contact with mucous membranes or blood?

Instruments that do not come into contact with mucous membranes or blood are considered non-critical instruments. In accordance with the CDC, these items require only cleaning followed by a low-level or intermediate disinfectant.

Instruments that do come into contact with mucous membranes or any amount of blood are considered semi-critical instruments. These instruments should be sterilized or treated with a high-level disinfectant after each use.


Foot Instrument Cleaning Solutions



Before disinfecting or sterilizing, all instruments must be cleaned. Your instrument cleaning solution should ideally be pH-neutral so it won't corrode your supplies. Miltex Surgical Instrument Cleaner is biodegradable and can be used with ultrasonic cleaners or a manual cleaning process.
This cleaner is also ideal for extended soaking. Miltex doesn't contain corrosives such as chlorines, phosphates or hydroxides.

To clean your instruments manually, use a small hand-held brush while keeping the instrument fully immersed. Rinse the cleaned instrument thoroughly under running water.



To keep movable joints from sticking, use Miltex Spray Lube after washing.
This lubricant prevents mineral deposits and greatly extends the life of instruments such as clippers.
Your instrument doesn't need additional rinsing after lubrication.
Cleaning versus Disinfection

During cleaning, foreign materials are removed from instruments with water and detergents. Cleaning is always a prerequisite step for disinfection. Instruments that are disinfected without cleaning will reduce efficacy of the disinfectants. This incorrect way of disinfecting will also result in particles drying or baking onto instruments.


Low-Level Instrument Disinfectants


Envirocide is a multi-purpose disinfecting solution for non-critical items and hard non-porous surfaces. Once your instruments are cleaned, rinsed and dried, this solution can be used for manual disinfecting in a tray or with an automatic disinfection in an ultrasonic unit. Within three minutes of immersion or continuous wet contact at room temperature, this solution effectively kills Mycobacterium tuberculosis, Staph aureus, Pseudomonas aeruginosa, Trichophyton mentagrophytes and Salmonella enterica.
This solution needs to be discarded after each disinfection procedure.

Intermediate Disinfectants


Intermediate-level disinfectants include phenols, iodiphors, alcohols and chlorine. Most of these chemicals will greatly reduce a range of disease-producing microbes on hard surfaces, however, not all can effectively kill Mycobacterium tuberculosis. In order to successfully address cross-contamination in our clinic, we always use an intermediate disinfectant with the ability to control this prolific bacterium.

MadaCide-1 is bactericidal, virucidal, fungicidal and tuberculocidal. In order to be effective against tuberculocidal activity, the treated surface must remain wet for at least five minutes.

In order to be effective against Hepatitis A Virus (HAV) and Poliovirus Type 1, this solution must remain wet on non-porous surfaces for 10 minutes. This product is also effective against Canine Parvovirus at 10 minutes.

MadaCide-1 is effective against HIV-1, micro-bacterium tuberculosis, salmonella choleraesuis, and mold and mildew. MadaCide-1 is noncorrosive, non-staining, nontoxic and biodegradable.



High-Level Disinfectants


Metricide28 is a buffered glutaraldehyde solution that can be re-used for 28 days. This solution will destroy most all microorganisms including Mycobacterium tuberculosis, vegetative bacteria, most viruses and most fungi. It can be used both as a sterilant or a high-level disinfectant.

This basic foot care instruments disinfection kit provides everything you’ll need for easy and time-saving high-level disinfection of sterilization. It includes brushes, a tray and Metricide28 solution in a 1-quart container.