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Occupational hazards associated with exposure to human nail dust
The use of podiatry drills, in the absence of engineering controls and personal protective equipment, is an occupational hazard to the healthcare provider. Nail dust collected during foot care procedures performed in office settings has been found to contain keratin, keratin hydrolysates, microbial debris, and viable fungal elements, including dermatophytes (most commonly ''Trichophyton rubrum'') and saprotrophs.〔Ward GW, Karlsson G, Rose G, Platts-Mills TAE (1989). "Trichophyton asthma: sensitization of bronchi and upper airways to dermatophytes anitigen". ''Lancet'' 8643, 859-62〕〔Abramson C (1990). "Inhalation of nail dust: A podiatric hazard". In McCarthy DJ, Abramson C, Rupp MJ (eds). ''Infectious Diseases of the Lower Extremities''. Williams & Wilkins, Baltimore 293-298〕 Exposure to nail dust and the associated risk will vary with the policies and practices in place, the type of podiatry drill used, therapy technique, frequency of procedures, personal protective equipment utilized and the use of ventilation systems.
==Nail dust generation==
Healthcare providers may use podiatry drills on onychauxic (thickened) nails of patients to alleviate or eliminate pain, prevent or treat subungual ulcerations, allow better penetration of topical antifungal agents, or improve cosmesis, all in effort to improve the patient’s “quality of life.”〔Woodfolk JA (2005). "Allergy and Dermatophytes". ''Asthma and Allergic Diseases Center, Clinical Microbiology Reviews'' 18 30-43〕〔McLarnon NA, Burrow JG, Price P, Aidoo KE, MacLaren W, Harper M, Hepher M, Edwards G (2005). "The controls of airborne hazardous substance in the healthcare environment", IOHA Pilannesberg: paper E1-1, 1-6〕 In a study conducted by Miller, 65% of respondents reported routinely drilling thickened toenails.〔Gatley M (1991). "Human nail dust: hazard to chiropodists or merely nuisance?" ''J. Soc. Occup. Med'' 41 (3) 121-5〕 However, the improved effectiveness of antifungal drugs such as itraconazole and terbinafine reduces the need to drill these infected nails.〔Sehgal VN, Jain S (2000). "Onychomycosis: clinical perspective". ''International Journal of Dermatology'' 39241-249〕
Podiatry drills have a mechanical rotating burr that can be set at a range of speeds usually up to 12,000 rpm and may or may not have an integrated local ventilation extraction system.〔http://www.podiatrytoday.com/article/775 7/5/07〕 Even with the most effective dust extractors, the electric nail debridement process is not totally risk free because the extractors range from 25% - 92% effective in reducing airborne particles.〔Abramson C and Wilton J (1985). "Inhalation of nail dust aerosols during reduction of onychomycotic toenails: I. Characterization of nail dust particles". ''JAPMA'' 75563 111-115〕〔Harvey CK (1993). "Comparison of the effectiveness of nail dust extractors". ''Journal of American Podiatric Medical Association'' 833. 12 669-673〕 While the large particles settle out to the floor, varying amounts of smaller particles remain suspended and are inhaled by or adhere to the practitioner and clinical environment.〔 The particle sizes range from 0.1 to 100 um and 86% of these particles are less than 5 um in diameter and therefore capable of entry into the alveoli.〔
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