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The PodiatryManual

Australasian Podiatry CouncilFirst in foot health


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Disclaimer

Every eort has been made to ensure that the information contained in this Podiatry Manual is ac-curate at the time of publication. Before relying on the information in this Podiatry Manual, however,users should check the currency of the information contained therein and completeness and obtainany appropriate professional advice relevant to their particular circumstances. Please contact theAustralasian Podiatry Council to report any errors or to seek clarication of any ambiguities. TheAustralasian Podiatry Council accepts no liability for any loss or damage suered by any person orcorporate body in reliance upon any information provided within this Podiatry Manual or the accu-racy, currency, completeness or interpretation of the information provided in this Podiatry Manual.

Copyright

Paper based publications

Australasian Podiatry Council 2013

This work is copyright. Apart from any use as permied under the Copyright Act 1968, no part maybe reproduced by any process without prior wrien permission from the Australasian Podiatry

Council. Requests and inquiries concerning reproduction and rights should be addressed to the Aus-tralasian Podiatry Council, 89 Nicholson Street, Brunswick East, Victoria 3057.


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ContentsUseful Information 5

Module 1 - Overview 71.1 Introduction 71.2 Registration and Accreditation 71.3 Role of the Podiatrist 81.4 Australasian Podiatry Council 9

1.5 Member Associations 10Module 2 - Clinical Practice Guidelines 112.1 Establishing a Clinical Facility 112.2 Clinical Records 152.3 Workplace Health and Safety 222.4 Clinical Coding 592.5 Quality Improvement 632.6 Infection Control 67

Module 3 - Extended Care 733.1 Domiciliary Care 733.2 Nursing Homes, Hostels and Day Therapy Centres 743.3 Foot Health in Residential Aged Care 75

Module 4 - Ethics and Legal Issues 774.1 Code of Conduct - Ethical Principles 774.2 Documentation, Condentiality 774.3 Negligence 814.4 Informed Consent 824.5 Strategies to Minimise Risk 83

Module 5 - Third Party Arrangements 855.1 Medicare 855.2 Podiatry and X-Ray Referrals 925.3 Department of Veterans Aairs 98

5.4 Transport and Work Accident Authorities 995.5 Private Health Funds 101

Module 6 - Before You Start in Practice 1036.1 Are you Ready? 1036.2 Buying a Practice or Establishing a Practice 107


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6.3 The Goodwill Component 1086.4 Planning Permits 109

Module 7 - Business Structures 1117.1 Introduction 1117.2 Sole Trader 1127.3 Partnerships 1137.4 Company 1207.5 Trust 123

Module 8 - Financial Management and Fees 125

8.1 Financial Requirements 1258.2 Banking and Bank Loans 1268.3 The Business Plan An Overview 1298.4 Other Financing Options 1308.5 Financial Records 1348.6 Australian Taxation Oce 1378.7 Budgeting and Financial Control 1398.8 Operating as a Locum 142

8.9 Insurance Programs and Policies 1458.10 Calculating your fees 146

Module 9 - Personnel and Employment Issues 1499.1 Sta Recruitment 1499.2 Important Issues when Employing Sta 1549.3 Administrative Sta 159

Module 10 - Marketing 163

10.1 Marketing and Promoting Your Practice 16310.2 Promotional Resources 165

Module 11 - Policies of the Australasian PodiatryCouncil 16911.1 Accredited Podiatrist Program (APP) Logo 16911.2 Aliated Bodies 17011.3 Trade Mark and Logo (Authorised Use) 172


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Useful InformationAustralasian Podiatry CouncilWebsites hp://www.apodc.com.au andhp://ndapodiatrist.org

Podiatry Registration Boardof Australia -hp://www.podiatryboard.gov.au

APodCCPD Online -hp://www.cpd.apodc.com.au/

Australasian College of Podiatric Surgeons- hp://www.acps.edu.au/

Australian Academy of Podiatric Sports Medicine Inc- hp://www.aapsm.org.au/

Contact Lists

Member Associations:

Australian Podiatry Association NSW & ACT Suite 20/450 ElizabethStreet, Surry Hills, NSW 2010. Phone (02) 9698 3751. hp://www.podiatry.

asn.au

Australian Podiatry Association QLD Coronation Place, 4/10 BensonStreet, Toowong, QLD 4066. Phone (07)3371 5800. hp://podiatryassocia-tionqld.org.au

Australian Podiatry Association SA Lvl 2, 50 Hu Street, Adelaide, SA

5000. Phone (08) 8210 9408. hp://podiatrysa.net.au

Australian Podiatry Association TAS 22 Lantana Avenue, Newstead,TAS 7250. Phone (03) 6344 2613. hp://www.taspod.com
http://www.apodc.com.au/http://findapodiatrist.org/http://www.podiatryboard.gov.au/http://www.podiatryboard.gov.au/http://www.cpd.apodc.com.au/http://www.acps.edu.au/http://www.aapsm.org.au/http://www.aapsm.org.au/http://www.podiatry.asn.au/http://www.podiatry.asn.au/http://podiatryassociationqld.org.au/http://podiatryassociationqld.org.au/http://podiatryassociationqld.org.au/http://podiatrysa.net.au/http://www.taspod.com/http://www.taspod.com/http://podiatrysa.net.au/http://podiatryassociationqld.org.au/http://podiatryassociationqld.org.au/http://www.podiatry.asn.au/http://www.podiatry.asn.au/http://www.aapsm.org.au/http://www.aapsm.org.au/http://www.acps.edu.au/http://www.cpd.apodc.com.au/http://www.podiatryboard.gov.au/http://www.podiatryboard.gov.au/http://findapodiatrist.org/http://www.apodc.com.au/


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Australian Podiatry Association VIC PO Box 248, Collins Street West,Melbourne, Vic 8007. Phone (03) 9286 1885. hp://www.podiatryvic.com.

au

Podiatry Western Australia Suite 16/88 Broadway Crawley, WA 6009.Phone (08) 6389 0225. hp://www.podiatrywa.com.au
http://www.podiatryvic.com.au/http://www.podiatryvic.com.au/http://www.podiatrywa.com.au/http://www.podiatrywa.com.au/http://www.podiatryvic.com.au/http://www.podiatryvic.com.au/


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OverviewModule 1 -

Introduction1.1This Manual has been produced by the Australasian Podiatry Council(APodC) and it is provided as a resource for members of state podiatryassociations.

The Manual provides an overview of some of the practice issues whichtheAustralasian Podiatry Councilbelieve are important to all practisingpodiatrists. However, the manual does not replace the need for sound pro-fessional advice, for example from a lawyer and / or accountant when con-templating either the purchase of a practice, or when planning to establisha new practice.

New members receive a complimentary electronic copy of the Manual at

the time of joining their association.

Registration and Accreditation1.2

Registration1.2.1

In Australia, podiatry is a registered health profession under the NationalRegistration and Accreditation Scheme. The scheme was formed under the

Council of Australian Governmentsand reports to theHealth MinistersCouncil. The Commonwealth is responsible for the operation of the schemewhich is administered by the Australian Health Professions Regulation

Authority (AHPRA). ThePodiatry Registration Board(PBA) is a boardthat is supported by AHPRA however it has statutory independence and isable to establish standards, policies, codes and guidelines nationally.

All podiatrists including students are required to be registered. Podiatrists

are not permied to practise if they do not hold registration. Registrationalso imposes further requirements such as the need to carry professionalindemnity insurance and the requirement to participate in continuing pro-fessional development.


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All new registrants are advised to review the requirements of the PBAwhich can be located at hp://www.podiatryboard.gov.au

Overseas Trained Podiatrists1.2.2

Podiatrists registered in New Zealand are eligible to apply for registrationin Australia under Mutual Recognition legislation. New Zealand podia-trists must not practice as a podiatrist in Australia until they have regis-tered with the PBA.

Podiatrists from other countries must undertake an assessment throughthe Australia and New Zealand Podiatry Accreditation Council (ANZ-PAC) which can be found at hp://www.anzpac.org.au

Role of the Podiatrist1.3To improve mobility and enhance the independence of individuals

by the prevention and management of pathological foot problemsand associated morbidity. This is achieved by providing advice onfoot health education, assessment and diagnosis of foot pathology,identication of treatment and other requirements, referral to otherdisciplines as appropriate, formulation of a care plan and provisionof direct care as deemed appropriate and agreed to by the indi-vidual.

To establish collaborative relationships with other health care pro-

viders.To promote the skills of the podiatrist and provide information re-garding footcare and appropriate support to other health profes-sionals and carers.

To ensure that communication with patients is respectful and re-mains condential.

To be a primary source of information for the community in all mat-

ters relating to the foot.To practise in accordance with developments in clinical practice,research and technology.

To ensure podiatry is conducted in a manner consistent with regis-tration requirements.
http://www.podiatryboard.gov.au/http://www.anzpac.org.au/http://www.anzpac.org.au/http://www.podiatryboard.gov.au/


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Australasian Podiatry Council1.4

TheAustralasian Podiatry Council(APodC) is the national peak body forpodiatry. The Councils members are the six state podiatry associations andthe role of the Council is to provide national services and policy directionfor the profession. The Council is a not-for-prot public company limited

by guarantee. The Council has a Board of Directors that are nominee direc-tors appointed by the member association (MA) who are responsible fordetermining broad strategy and for the governance of the organisation.The Council has a professional sta who are responsible for management

and operations.

The APodC provides some services directly to podiatrists on behalf of thestate association, such as the national conference, Podiatry Bulletin, CPDonline, and resources infection control guidelines, podiatry manual, bill-ing guide. These services are provided collectively to all member podia-trists nationally. They are funded in part through member subscriptionspaid by podiatrists to their state association and partly through commer-

cial revenues such as advertising and sponsorship.

The APodC also has a signicant role in establishing a national brand forpodiatry, seing standards and advocating for the profession nationally.The APodC advocates in a wide range of national areas including:

National Registration and Accreditation

Medicare and MBSPrivate Health Insurers (including 30% rebate and PHI legislation)

Pharmaceutical Benets Scheme

Health Workforce Australia (National prescribing, workforce edu-cation, workforce planning)

National Council on Safety and Quality in Healthcare (practicestandards) Department of Veteran Aairs

National Workers Compensation Schemes

Taxation, GST and other health business issues

JFAR Journal of Foot and Ankle Research


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Member Associations1.5

The Member Associations in Australia represent podiatry to state govern-ments and the community at large. They provide a range of services formembers to enhance professional competence and improved standards ofpractice. Some of these services or programs include:

Professional development and education - including annual stateconferences and a range of continuing education programs.

Representation of the profession to state government and statebased agencies.

Work opportunities - use of the Member Association listing eitherto nd work or recruit an employee.

Use of newsleer classieds. Referral of public enquiries to localpractices.

Resources - access to the comprehensive resource library including:multi-media, stands, lanyards. Access to the JFAR journal is openaccess.

Promotions - opportunity to promote the profession in the com-munity and amongst other health professionals, and have access toquality cost eective promotion resources.

Recognition - members may promote their aliation through titleand also use of the trademark P logo.

Information - provide answers to member enquiries through theMember oce.

Representation on state industry bodies.

Liaison with podiatry schools regarding undergraduate and post-graduate education; also short courses.

Nominating a Director to the Australasian Podiatry Council to de-velop national policies and programs.

Newsleers/e-news - newsleers and e-news keeping membersabreast of current local issues, practical information, education,and association activities.


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Clinical PracticeModule 2 -Guidelines

Establishing a Clinical Facility2.1

Facilities2.1.1

When establishing a clinical facility, consideration should be given to fac-tors which will inuence the comfort and safety of both the practising po-diatrist (and any potential colleagues or other sta) and the clientele. Clini-cal facilities should be clean (and easy to keep clean) and ings kept to aminimum, thus minimising the risk of cross-infection.

In view of potential clientele, consider access to the facility, including prox-imity of public transport, parking availability and disabled access to the

premises. Toilet facilities should be available for both patients and person-nel. If a podiatrist is likely to be working in isolation, extra security mea-sures and medical emergency requirements may require special consider-ation. Compliance with Infection Control Standards (refer to Module 2.6:Infection Control) and Workplace Health and Safety requirements (refer to

Module 2.3: Workplace Health and Safety) should be observed.

Note: All items are supplied by the employing body if the podiatrist is in a

salaried position.

Clean, well-lit and well ventilated clinical room.

Adequate oor space (minimum recommended 3.5 m x 3.5 m).

Washable oor surface, eg; vinyl or tiled - not carpet (refer to Mod-ule 2.6: Infection Control).

Hand basin with hot and cold running water, taps with hands o controls and suitable drying facilities, such as single-use papertowels (not mechanical or electrical dryers) - refer to Module 2.6:Infection Control.

Separate stainless steel facilities for cleaning instruments -refer toModule 2.6: Infection Control.


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Adequate facilities for sterilisation as per Australian and New Zea-land Standards(refer toModule 2.6: Infection Control).

Minimum of two double power points.

Rubbish disposal to include general waste, suitable containers forinfectious waste and sharps disposal receptacle - all appropriatelylabelled and with suitable arrangements for collection. Suitable ar-rangements must be made for the clinical facility to be cleaned aereach session, including cleaning of all exposed surfaces and empty-ing of bins.

Separate waiting room and reception area.Extra space may be required for oce and desk (suitable writingspace is required within the clinic for report writing and correspon-dence).

Separate area for orthotic manufacture and construction, includingbench grinder with dust extraction, small bench oven, plaster and

materials storage and possibly a vacuum press. Adequate benchspace is required for assembly and adequate ventilation for glu-ing. Consideration should be given for the inclusion of a plastertrap below the sink at which plaster-soiled water is rinsed. The areashould comply with Workplace Health and Safetyregulations andallow safe work practice (refer toModule 2.3: Workplace Health andSafety).

Lockable storage is advisable for security purposes and necessaryif restricted substances and pharmaceutical prescription pads are

kept on the premises.Equipment2.1.2

This outlines the basic minimum equipment recommended by the Aus-tralasian Podiatry Councilto establish a podiatry service.

Electrohydraulic patient chair , with reclining back and adjustableleg rest. A chair that converts to a plinth is recommended as it en-

ables biomechanical assessments to be performed. In multipurposeclinics this also increases the chairs versatility.

Hydraulic height-control podiatrists chair with adjustable lum-bar support, on ve castors.

Cabinet / trolley with castors to accommodate equipment and ma-terials during treatment.


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Adjustable lamp (e.g. luxo or planet) with magnier or lamp withcolour corrected globe. Lamp may be portable on castors or at-

tached to trolley.Electric nail drill with dust extraction or spray.

Autoclave - steriliser using steam under pressure (refer toModule2.6: Infection Control). This is not essential if an o site sterilisationservice is used.

Adjustable footrest for wheelchair bound patients.

Disposables - again individuals will have diering preferences -

however disposable gloves, dressings, various medicaments andpharmaceutical preparations, plaster bandage and orthotic materi-als will be among the requirements.

Diagnostic equipment , including angle grinding tools for orthoticadjustment and gait analysis facilities for biomechanical assess-ment, and appropriate vascular, neurological and other clinical as-sessment tools e.g. doppler, tuning fork, reex hammer, sphygmo-manometer.

Orthotic fabrication materials might include knives, scissors, gluesand a variety of rubbers and polypropylenes with suitable safetyequipment (refer toModule 2.3: Workplace Health and Safety).

While a practice may be started with manual records, we advise theuse of computer based billing and patient records for accountingand invoicing, patient bookings and data collection and collation.

Internet access . Also consider several phone lines for separate EFT-POS from incoming phone/fax line.

A secure system for computer backups, recording patient informa-tion, with suitable stationery and lockable storage facilities.

Appointment book (if not computerised).

Pens, notepaper, envelopes and leerhead writing paper of the con-sulting podiatrist (or managing authority that administers the ser-vice) for correspondence with other persons related to care of thepatient.

Filing system and space.

One trolley (preferably stainless steel) with easily cleaned surfaceon balanced castors and with two shelves or trays equipped withmedicaments and dressings as specied by the podiatrist.


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The podiatrist will also require access to a minimum of one (1)power point, a wash basin with hot and cold water and disposable

(paper) dressing towels, appropriate rubbish disposal for generaland infectious waste and sharps and access to patient medicalrecords for recording treatments.

For transporting equipment, a lightweight, compact carry case thatis easily cleaned, to carry the minimum of medicaments, dressings,felt, etc.

Sterilised sets of instruments, the number of sets equal to the num-ber of patients to be treated. Sets of instruments are to be sterilised

individually, prior to the home visit. Packaging should be in sucha way as to maintain sterility of the instruments whilst transport-ing equipment to/from the patients home. A separate container forreturn of used instruments to the sterilising area.

The following special procedures pertain to home visits:

Hand Washing

Refer to the Infection Prevention and Control Guidelines for Podiatrists2012 for recommendations on hand washing.

Waste Disposal

General waste- disposed of in the patients garbage bin.

Contaminated waste- to be returned to the place of employment for appro-priate disposal as per the Infection Prevention and Control Guidelines.

Sharps- placed in a designated sharps container carried into the patientshome. Small containers made for their easy portability in such situationsare available. Ensure that the container can be closed during transportationand reopened again for use.

Soiled Linen

Soiled linen should be segregated according to the Infection Preventionand Control Guidelines or alternatively the patients own linen can be uti-lised.


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Health Education

Foot health education may be required for other health professionals, formembers of the public or special interest groups such as diabetes or arthri-tis support groups.

In order to provide this service, the podiatrist will require access to audiovisual materials (e.g. DVDs, posters, pamphlets, models), library facilitiesfor researching lecture topics, and projection equipment.

Most Member Associations have available to their members a range of au-dio visual aids and equipment for loan.

TheAustralasian Podiatry Council produces other resource materials foruse in promotional activities which are available to members electroni-cally.

Clinical Records2.2The preparation and maintenance of high quality patient notes is an essen-tial part of a podiatrists duties. It is imperative that the clinical facility hasa system for the recording of such information. The system should allowappropriate access, processing and storage of patient records and ensurecondentiality requirements are met.

TIP: High quality patient notes help practitioners to justify/defend their ac-tions if they are ever challenged for negligence or are subject to a complaintreceived by the Podiatry Registration Board of Australia. Conversely,poor quality notes, or a total lack of notes undermine a good defence, andcan be grounds for disciplinary action against the podiatrist in itself.

Condentiality & Privacy2.2.1

As patient records contain information which is highly personal and sen-sitive in nature, it is important that the practitioner and clinical facilityrespects the right of individual privacy and ensures steps are in place tofacilitate appropriate use, access and storage of records. There is further in-formation found at hp://www.privacy.gov.au/materials/types/infosheets/view/6583including 10 National Privacy Principals.
http://www.privacy.gov.au/materials/types/infosheets/view/6583http://www.privacy.gov.au/materials/types/infosheets/view/6583http://www.privacy.gov.au/materials/types/infosheets/view/6583http://www.privacy.gov.au/materials/types/infosheets/view/6583


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All handling of clinical records must comply with Federal and State / Ter-ritory Privacy Laws. Please go to the Oce of the Australian Information

Commissioner web sitehp://www.oaic.gov.au (search for health) fordetails on Federal laws and links to state laws.

The laws detail requirements related to the collection, storage, use, accessand disclosure of patient information in the context of health service pro-viders. The National Privacy Principlesprovided aim to promote goodprivacy practice in the health care seing.

The rights of the patient regarding access to their medical records are alsocovered under this legislation. Generally patients have the right to accessany information about them which is held by the practice; however certainlimitations apply where it is in the patients best interest to limit access (eg.A psychological condition may be aected). Please go to hp://www.oaic.gov.au(search for health) for more information.

While patients have access to their own health record, practitioners shouldbe cautious about releasing records to third parties. While there are provi-

sions to pass on information to other health providers for the continuedtreatment of the patient, and where the patient would have a reasonableexpectation that this would occur (e.g. a report back to a referring doctor),practitioners should be cautious in releasing information. The law doesnot require a release of information to any party other than the patient. Ifpractitioners are unsure of whether a reasonable expectation exists, theyshould check with the patient. If the patient refuses to grant permission

then the information should not be released, as practitioners are requiredto maintain condentiality under the privacy legislation.

Report Writing2.2.2

The patients record constitutes an ongoing account of the service providedto an individual, oering a record of treatment given, progress made anda history for future consultation as required. For podiatry guidelines onclinical records (set by the PBA) see hp://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspx . Increasingly, statistical information is ac-quired from the patient record, occasionally the record may be used forteaching and research purposes and there is always the potential that a pa-tients record will be required as evidence in court. It is important therefore
http://www.oaic.gov.au/http://www.oaic.gov.au/http://www.oaic.gov.au/http://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspxhttp://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspxhttp://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspxhttp://www.podiatryboard.gov.au/Policies-Codes-Guidelines.aspxhttp://www.oaic.gov.au/http://www.oaic.gov.au/http://www.oaic.gov.au/


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that patient records meet a minimu m standard, having regard for theirpurpose.

Reports should be accurate, brief, complete and include referenceto any patient refusal of treatment or action contrary to advice.

Reports should be legibly wrien and include the signature of theaending practitioner. In multiple practitioner clinics and surgeriesit is recommended that the practitioners name is also printed assome signatures are dicult to identify.

Reports should be objectively wrien, based upon facts.Entries should be made at the time of consultation and should berecorded in blue or black ink.

All correspondence and any other reports concerning the patient(e.g. pathology or radiology reports, detailed assessments, orthoticprescriptions), should be led in the clinical record.

Any telephone conversations with the patient and any consultation with

any third party should be recorded in the clinical record. Abbreviationsshould not be used in clinical reports unless they are accepted by the clini-cal facility and included in that facilitys List of Common Abbreviationswhich is documented to include the facilitys accepted interpretation ofeach abbreviation.

Any errors made whilst writing an entry in a patients manual re-cord should be dealt with by drawing a line through the incorrect

entry and initialling it before continuing. Correction uid may notbe used.

No entry concerning a patients treatment should be made in a pa-tients record on behalf of another practitioner.

In a multi-disciplinary facility, the reports of all health personnelinvolved in caring for the patient should be part of an ongoing,integrated, holistic record.

References

Australian Council on Healthcare Standards Ltd. (1996) The ACHS ac-creditation guide. Standards for Australian health care facilities. 13th Ed.


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Australian Community Health Association. (1993) Community HealthAccreditation and Standards Program (CHASP). 3rd Ed.

The Oce of the Privacy Commissioner, Privacy Law Website: hp://www.privacy.gov.au/law

MacFarlane P. (1995)Health Law. The Federation Press

Staunton PJ, Whyburn B. (1993) Nursing and the Law. W.B.Saunders/Bail-

liere Tindall

Documentation Format2.2.3

An ordered approach to documentation of patient related information willassist with maintenance of record standards, (particularly where more thanone podiatrist is practising from the one location) and help to ensure thatall relevant information is captured. It will also provide a basis for quality

improvement and research projects.

An example Assessment and Care Plan format is included for your guid-ance.
http://www.privacy.gov.au/lawhttp://www.privacy.gov.au/lawhttp://www.privacy.gov.au/lawhttp://www.privacy.gov.au/law


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Podiatry Assessment & Care Plan


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Appendix the Footwear Assessment Form

General shoe style/covering Heel counter stiness

barefoot minimalsocks only 45

backless slipper Longitudinal sole rigidity

mule minimal

high heel 45

boot Sole exion point

slipper at level of MTPJs

sandal before MTPJs

moccasin Tread paern

athletic shoe textured

walking shoe smooth (i.e. no paern)

Oxford shoe partly wornugg boot fully worn

thong Sole hardness

surgical/bespoke footwear so

Heel height rm

02.5 cm hard

2.65.0 cm

>5.0 cmFixation

none

laces

straps/buckles

Velcro

zips

ReferenceMenz HB, Sherrington C, The Footwear Assessment Form: a reliable clini-cal tool to assess footwear characteristics of relevance to postural stabilityin older adults - Clinical Rehabilitation2000, 1999.


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Workplace Health and Safety2.3

A safe working environment in accordance with all Workplace Health andSafetyregulations is an important responsibility to uphold by all podiatryclinic owners, managers and podiatry practitioners. The wellbeing of eachperson in the workplace is vital and thus the process of managing, control-ling or eliminating risks and establishing safe systems of work, as requiredunder Workplace Health and Safety legislation, is important for the follow-ing reasons:

Your personal health and safety, as well as the health and safety ofeveryone working in, and entering, the clinic. A work related in-

jury or disease can result in unexpected costs, the absence of a stamember and unnecessary emotional and psychological stress.

The penalties for failing to comply with Workplace Health andSafety laws are high and include criminal sanctions such as impris-onment.

There are potential hazards in podiatry clinics and therefore the risk ofharm or injury to persons who work in these environments and personswho visit these areas must be recognised. Due to the nature of duties, safe-ty standards should in particular address the risk of physical injury and ofcross-infection. The fundamental steps involved in developing a safety sys-tem for all practices are: identify hazards, assess risks and control risks.

It is important to be aware of anything that could go wrong, the eect that

this would have on people, equipment and the clinic and how to preventsuch an occurrence. Adequate time during consultations and between pa-tients must be allowed to ensure adherence to safety standards. Podiatrypractised in sub-standard conditions brings a risk of infections to the pa-tient and possible injury to the podiatrist.

While general principles and information is provided, state / territoryworkplace health and safety requirements vary. It is your responsibility to

nd out the requirements which apply to you.

Your Business and the Law2.3.1

Workplace health and safety is everyones responsibility


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Whether your clinic is big or small, whether it is based at one location ormany, whether you are an owner operator or an employer, you are legally

required to make sure that the working environment is safe and withoutrisks to health. You must also ensure that no one else, like your patients,visitors or neighbours are put at risk because of your work activities.

Workplace Health and Safety (WH&S)2.3.2legislation

Workplace health and safety in Australia is legislated by separate Acts in

each State/Territory. Safe Work Australiais the national organisation thatestablishes policy on workplace health and safety. Links to state health andsafety bodies may be found at hp://safeworkaustralia.gov.au.

State legislation species duties for the following parties:Employers

Persons in control of workplaces

Employees

Self-employed persons

Manufacturers and suppliers of plant and substances

Persons erecting or installing plant in a workplace

As an employer, you have a legal responsibility called a duty of care toprotect the health, safety and welfare of people in your workplace. This

includes people who work for you casually, part-time, full-time, perma-nently, as volunteers or as outworkers, plus members of the public whilethey are in your workplace.

Employees also have a duty of care. They should follow instructions relat-ing to health and safety, and avoid puing other people at risk.

The Acts cover other maers such as how to deal with WH&S issues and

how the law will be enforced, the roles of inspectors, notices, penalties,etc.

Inspectors have the power to enter workplace premises and, where appro-priate, issue Improvement or Prohibition Notices requiring that hazards be
http://safeworkaustralia.gov.au/http://safeworkaustralia.gov.au/


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remedied within a specied period or that a work activity be suspendeduntil the hazard is removed. Failure to comply with such a notice is an of-

fence. It is also an oence to obstruct, hinder or deceive inspectors in thelawful course of their duties.

Regulations2.3.3

The general duties in the Acts are supported by more detailed require-ments set out in regulations for issues such as:

Manual handling

Hazardous substances

Noise

Plant

Conned spaces

Fact sheets and links to the regulations may be located on the website of

your state worksafe / workcover authority.

Guidance Material2.3.4

Codes of Practice, National Standards and Australian Standards providepractical guidance on how to achieve the standard of health and safety re-quired by the Acts and regulations. A Code of Practice should be followedunless there is another way to get an equal or beer outcome.

Workplace Health and Safety laws2.3.5require employers to:

Provide a safe workplace and safe systems of work.

Maintain equipment, tools and machinery in a safe condition.

Provide safe and hygienic facilities, including toilets, eating areasand rst aid.

Provide information, instruction, training and supervision to allworkers.

Establish a process for consultation with workers.


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Monitor and record work-related injuries and illnesses.

Notify any workplace death or serious injury, or any incident that

could have caused death or serious injury.

hp://www.business.gov.auprovides a good resource for business owners,managers and employees on WH&S.

Steps to Developing a Workplace2.3.6Health and Safety Program

Aworkplace health and safety(WH&S) program is a planned set of activi-ties needed to make your work and workplace safe. It ensures that hazardsin your workplace are managed in a systematic way.

An WH&S program helps to protect your clinic, employees, patients, andyour personal liability as an employer, owner, manager or supervisor. Itwill enable you to comply with workplace health and safety legislation andreduce costs associated with work-related injury and disease.

Every business should take these simple steps to improve the way theymanage health and safety in the workplace. In a small business, this is bestachieved if each step is incorporated into the day-to-day operations of the

business, to reduce duplication of eort.

hp://www.business.gov.aurecommends the Victorian Government Work-

place Health and Safety Guide as a starting point. It can be located at hp://www.business.vic.gov.au (search WH&S). The steps to geing startedare:

Step 1 Know your responsibilitiesFind out the legal workplace health and safety requirements that apply toyour business. Then write a health and safety policy to demonstrate yourcommitment to a safe workplace.

Step 2 Involve your workersTalk to your sta and set up ways for them to be involved and contribute todecisions that may aect health and safety in the workplace.
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Step 3 Identify hazardsFind all the things that could cause harm to people in your workplace.

Step 4 Assess the risksDetermine how serious these hazards are.

Step 5 Manage the risksDont wait for someone to be injured or fall ill. Fix the health and safetyproblems by nding ways to remove the hazards or ways to keep peoplesafe from them.

Step 6 Inform, train and superviseInform sta about hazards in their job and workplace as well as the re-quirements for health and safety in your clinic. Safe work procedures can

be used as a training tool. Ensure new workers are properly supervised.

Step 7 Put safety into purchasing

Consider health and safety risks before hiring contractors or other servicesand before buying equipment or materials. Incorporating health and safetyat the purchasing stage is more cost-eective and is likely to reduce timerequired for training and supervision.

Step 8 Manage injuriesPlan to respond appropriately and reduce the impact of an incident/injuryif it occurs.

Step 9 - Keep recordsKeep records of your safety activities so that you can monitor and reviewthe health and safety performance of your business.

Step 10 Monitor, review and improveReview the steps you have taken to manage health and safety in yourworkplace. Adjust your program to address any business or legislativechanges.


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Hazards in Podiatry Clinics -2.3.7Ergonomics and Podiatry Equipment

Manual tasks involving repetitive procedures, forceful exertions and hold-ing constrained or awkward postures for a long time can result in muscu-loskeletal injuries.

Common problems

Lower back pain caused by standing for long periods of time,adopting awkward positions, siing on chairs or stools without a

back rest or leg support.

Neck and shoulder pain (tendonitis) caused by prolonged staticpostures, bending the head forward or to the side, holding armsaway from the body or above shoulder height.

Wrist and hand problems (carpal tunnel syndrome) caused bygripping, repetitive movements, e.g. scalpelling, grinding and pol-

ishing.The following factors should be considered to help you decide howto reduce the risk of musculoskeletal injury:

Clinic layout and furnitureProvide enough space to allow free movement around work areasand furniture.

Arrange equipment and materials on workbenches within easy

reach.

Store heavier and frequently used items at waist level to elimi-nate the need for liing from below mid-thigh or above shoulderheight.

Adjust podiatry chairs to position the patient so that you do nothave to bend or twist your back.

Operator chairs should be height adjustable with good lumbar sup-

port, and have a ve-point base on castors.

Design workstations so that sta can do most of their work in anupright position with shoulders lowered and upper arms close tothe body. The working height and objects used in the task should beroughly level with the elbows, whether the work is done siing or


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standing. People vary in stature and may require dierent workingheights. So it is best to use adjustable workstations that can be set

to suit the height of each person.Work organisation

Vary tasks as much as possible to use dierent muscles and allowtired muscles to recover.

Alternate between siing and standing.

Tools and equipment .

Select tools and equipment where the shape and orientation of

handles allows a comfortable grip and avoids awkward wrist posi-tions.

Use well balanced, lightweight tools and instruments to reducehand and arm fatigue. Use larger diameter grips on instrumentssuch as les or curees to reduce nger pinching.

Maintain all cuing and grinding tools (burs, discs) so that they donot require extra eort to use.

Liing techniques - the following principles should be followedwhen liing:

Plan the li - assess the load, determine where it will be placed andhow it will be handled.

Adopt a comfortable, balanced posture with feet slightly apart.

Face the load squarely and securely grip the item with both hands.

Position the load close to the body.Li gradually and smoothly, without jerking.

Avoid twisting the back - turn the feet, not the hips or shoulders.

Team liing principles :

Organise a team of adequate numbers of persons who are of similarheight and capacity, and trained in manual handling techniques.

Appoint a person to coordinate the li.

Plan and rehearse the li with the team.

Use the safest, most comfortable liing technique.

Team liing should only be used when mechanical liing equip-ment is unpractical.


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Podiatrists ChairCorrect posture must be maintained during treatment. This includes feet

at on the oor, hips exed at 90% (or slightly extended) to upper bodyand a straight back with the lower lumbar curve maintained. A chair that istoo low increases exion at the hip and promotes poor back posture.

The following features are considered essential on a podiatrist chair:

Hydraulic height control

Variable height control to accommodate dierent seating heights.The height of the podiatrists chair should remain static throughouttreatment and the patient chair adjusted to enable access to dier-ent parts of the foot. A sucient height range on the patient chairis therefore vital. The podiatrists chair height should only be ad-

justed on those rare occasions when the patient chair height is notadequate. Consider seating that is designed to be more ergonomicfor your professional needs: hp://bambach.com.au/.

Swivel seat / castors

The podiatrist needs to be able to move from side to side aroundthe feet and turn to the trolley to collect materials, without twistingthe upper body. (A combination of twisting and reaching has beenimplicated as the cause of many back problems.) A ve castor baseincreases manoeuvrability and non-carpeted oor surface ensuresthis.

Adjustable lumbar bar / back rest

The lumbar bar / back rest supports the lumbar spine and helpsmaintain correct back posture. It must be adjustable to cater for dif-ferent sta. If the patient chair can be raised high enough, it is notunreasonable for the podiatrist to work standing up. This tends tolimit the amount of lumbar spinal rotation which is a causative fac-

tor in many spinal injuries.

Patients Chair

A height adjustable hydraulic chair is vital in any clinic. It enableseasy patient access and treatment of all aspects of the foot whilstmaintaining correct posture of the podiatrist.
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High chairs with steps are to be avoided as they immediately pro-hibit access to people with mobility problems such as the very frail

and patients with hip replacements. Such chairs should only beemployed on a temporary basis or in areas that receive a minimalservice and have fairly mobile patients.

A moveable arm rest improves access from the side of the chairinstead of climbing over the leg rests. Provide assistance where nec-essary to assist the safe transfer of patients into and out of the chair.The material on the chair should be easily cleaned, vinyl is great.

Also refer to the infection control guidelines for cleaning materialas a cloth is not suitable.

An adjustable back rest enables the chair to be converted to a plinthfor biomechanical examinations and also multi-purpose use by oth-er health professionals. An adjustable back rest is also essential toaccommodate patients who cannot ex their hips greatly aer hipsurgery.

Electric hydraulic control

Foot control enables quick height adjustments whilst podiatrist re-mains seated. Manual height-adjusted chairs force the podiatrist tochange their chair height during treatment and so correct back pos-ture is not always maintained. These chairs may be appropriate foroccasional use only, ie, no more frequent than once a week.

Height range

Podiatrists will dier in the chair height they comfortably work at,but most will work in a range of 70-95 cm. Taller podiatrists will of

course require a higher range. Patient chairs should therefore riseto a minimum heel height of 90 cm (i.e. the patients feet can beraised to that level for comfortable working position).

Portability

It is oen advantageous for the chair to be on castors for easy move-ment into a corner or another room, and for oor cleaning(thoughmost good patient chairs do not have castors.) During the use of thechair the wheels can be locked into place.


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Trolley/Cabinet

The trolley / cabinet should be on castors to keep materials and

instruments within easy reach of the podiatrist or moved out ofthe way for beer access to the feet. (This prevents excessive reach-ing and twisting of the upper body.) The trolley should be at deskheight (approximately 74 cm) for easy access. Ideally the trolleyshould contain a lockable cupboard or drawer in which to perma-nently store materials. However, a trolley consisting of shelves isconsidered adequate.

Reducing the Risk of Incidents

Educate your sta and colleagues about the risk of injury when us-ing podiatry chairs. Maintaining a safe environment is everyonesresponsibility.

Its not uncommon for clients to behave in a way you didnt expect.Dont assume they will act safely.

Ensure the chair is positioned at the lowest seing before a cliententers the room.

If you leave the room while the client is undressing, instruct themnot to sit on the treatment chair or the podiatrists stool until youreturn. Make a conventional chair available as needed.

Supervise the client geing on and o the chair. Instruct them notto aempt to reach out or get o the chair without your help.

Adjust the base of the chair to ensure it sits level on the oor. Keepany wheels locked at all times. Avoid moving the chair unnecessar-ily to prevent leaving the wheels unlocked.

Consider how a clients size and weight may impact the stability ofthe chair, particularly when the chair is raised.

Do not allow children to play on or under the chair.

Reduce cluer in and around the treatment area. Keep equipmentor other objects away from the chairs foot switch to avoid acci-dently activating the pedal.

Perform regular housekeeping to remove hazards that may causeinjury.

Consider the benets of using signage to further alert clients to thedangers of not following safety instructions.


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Safety equipment/PPE (personal2.3.8protective equipment)

The following should be available for the podiatrists use to prevent injuryand infection in the clinic and workroom (see the Infection Prevention andControl Guidelines for Podiatrists at hp://www.apodc.com.au/):

Eye protection

High ltration mask

Sterile and non-sterile glovesGown / Apron

Podiatrists practising in institutional facilities including hospitals andnursing homes should be aware of the dangers associated with liing andtransferring of patients on-site. Training in local transfer techniques is ad-vised as is the use of assistance of sta members. If treatment of patients atthe bedside is unavoidable, the number treated in any given session should

be limited and the podiatrist should avoid potentially injurious posturesand take frequent breaks.

Hazardous Substances2.3.9

Podiatrists use a wide range of materials. Many of these products maycontain chemicals that are classied as hazardous substances. Exposure tothese chemicals can increase the risk of various health problems.

Hazardous substances can enter the body through the skin, by inhalationor by swallowing. Acute he alth eects, such as eye and throat irritation,may occur almost immediately aer exposure. Chronic health eects, suchas allergic contact dermatitis or cancer, take some time to develop.

The likelihood of a hazardous substance causing health eects depends ona number of factors, including:

The toxicity of the substance

The amount of substance that workers are exposed to

The duration of exposure
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The frequency of exposure

The route of entry into the body, e.g. skin absorption, inhalation or

ingestion

You can determine whether a product is hazardous to health by reading itslabel and the material safety data sheet(MSDS).

Hazardous substances laws2.3.10

Most jurisdictions have introduced hazardous substances regula-

tions under workplace health and safety laws. These regulationsapply to all workplaces where hazardous substances are used orproduced. To ensure that workers are not exposed to health andsafety risks, the regulations require employers to:

Obtain information about the chemicals used in the workplace.

Find out what the risks are (conduct a risk assessment).

Control the risks by eliminating or reducing exposure to the sub-

stance.Provide training in the safe use of these substances.

Conduct air monitoring (if required).

Arrange health surveillance (if required).

Keep records, such as a register of hazardous substances, currentMSDS, risk assessment results.

The following table lists some of the hazardous substances used in podia-try clinics and their potential risks:


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Product HazardousSubstance

Risks

Wart treatment/nail surgery

Liqueed phe-nol

Causes burns to skin and eyes

Trichloroacetic(Monochola-cetic) acid

Corrosive causes burns to skin, va-pours irritating to eyes and respira-tory system

Histofreezer -Cryosurgicalsystem

Dimethylether PropaneIsobutene

Flammable, causes freezing on con-tact with skin and eyes, inhalation ofvapour causes headaches, dizziness

Plaster of paris Calcium sul-phate

Dust harmful may aggravate respi-ratory conditions

Methylatedspirits (cleaningsolvent)

Ethyl alcohol Highly ammable, harmful to eyesand respiratory system

Disinfectants Quarternaryammoniumcompounds

Irritating to eyes and skin

Gluteraldehyde Toxic, irritating to eyes, respiratorysystem and skin headaches, nau-sea, asthma, allergic contact derma-

titisAdhesives Solvents Highly ammable, harmful to skin,

eyes and respiratory system

Medicament Potassium hy-droxide

Caustic

Grindingstones/wheels

Aluminiumoxide Siliconcarbide Zinc

oxide

Inhalation of dust and fumes harm-ful

Gases Propane Bu-tane

Highly ammable, asphyxiant


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Where to Get Information2.3.11

Labels

Ensure that containers of chemicals and other substances in yourworkplace have labels aached. A label must be in English and dis-play the product name, risk and safety phrases, dangerous goodssymbols (identifying dangerous properties e.g. ammable, toxic,corrosive) and directions for use.

Ensure that the contents of a container can be easily identied and

used correctly.

Always store chemicals in original containers.

If a chemical is transferred from one container to another, and thesubstance is not entirely used immediately, you must ensure thatthe second container is properly labelled and will not react with thechemical. Do not pour chemicals into food or beverage containers.

If the contents of a container are unknown, it should be labelled:

CAUTION: DO NOT USE UNKNOWN SUBSTANCE.

Store all unknown substances in isolation until the contents can beidentied and properly labelled. If the contents cannot be identi-ed, they should be disposed of in accordance with local WasteManagement requirements.

Material Safety Data Sheets (MSDS)

MSDS are a major source of information about a chemical product and isadditional to the information provided on a label. It contains informationabout chemical ingredients, potential health eects, precautions for use,safe handling and storage, rst aid and emergency procedures.

The value in having an MSDS is that this information can be incorporatedinto your work practices. You are required to keep a register containing alist of all hazardous substances used in your workplace and a copy of thecurrent MSDS for each substance.

The supplier of the product must provide an MSDS for each hazardoussubstance with the rst order and also upon your request. Manufactur-


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ers and importers of hazardous substances are responsible for preparingMSDS. An MSDS should not be more than ve years old.

An MSDS should alert you by providing enough information to identifywhere a chemical may release another hazardous substance during nor-mal use. MSDS should be available where chemicals are stored, mixed orused.

Self-employed persons should note that they cannot ensure their ownhealth and safety unless they are familiar with MSDS information for the

substances they use.

Risks associated with a chemical can aect the way it is used and stored.Therefore, it is important to know what chemicals are used, the potentialrisk of using the chemical and ways to reduce the risk. This is why a RiskAssessment must be done and why all materials used in the podiatry clinicmust have MSDS.

How to do a Risk Assessment for2.3.12Hazardous Substances

Divide your work into tasksLook at each work process and divide it into separate tasks. Include pro-cesses such as cleaning the clinic.

Identify all substances used and released in the processMake a list of all the products and materials that you use in each task, e.g.(example) adhesive, disinfectant, plaster. Check processes that release air-

borne contaminants such as dusts, fumes, vapours or mists.

Find out which substances are hazardousCheck the label and MSDS to nd out whether the product contains a haz-ardous substance or not. If you are unsure whether a substance is hazard-ous, contact your supplier.

Obtain information about the hazardsRead the label and MSDS for each hazardous substance to nd out how itshould be used and stored safely.


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Inspect and evaluate exposureThe work process should be analysed to nd out how each substance is

being used:Are workers being exposed to the hazardous substance?

How oen are they exposed? For how long? How much are theyexposed to?

What is the route of exposure? (e.g. skin or eye contact, inhalation,ingestion).

Are safe operating procedures in place (e.g. lids replaced on con-

tainers immediately aer use)? If so, are they being followed?Are control measures in place (e.g. fume/dust extraction system)? Ifso, how eective are they?

In some instances it may be necessary to have the level of hazardous sub-stances in the air monitored.

Evaluate the risk

Information from the previous steps should enable you to establish wheth-er the risk for adverse health eects is high, medium or low, dependingon:

The nature and severity of each hazardous substance

The degree of exposure to persons in the workplace

Whether existing control measures adequately reduce exposure

Decide what to do to control the risk

In most cases, controlling the risk will simply involve following the pre-cautions described in the MSDS. Ensure that your sta are trained in usingchemicals safely and have access to the MSDS. You will also need to set adate for reviewing the work processes to check that exposure levels remainacceptable and that sta are monitored for adverse health eects.

Controlling Exposure2.3.13

Eliminate exposure to hazardous substances

Remove hazardous substances from the clinic (if possible).

Substitute with a less hazardous substance.

Use a disinfectant that does not contain harmful gluteraldehyde.


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Isolate the substance from the operator.

Use and store adhesives in a fume cabinet.

Engineering Solutions2.3.14

Modify the process to reduce exposure:

Trimming insoles with scissors instead of grinding reduces expo-sure to dust.

Use dust extraction systems with grinders and drills.

Administrative controls safe work practices

Store chemicals away from energy sources, such as fuse boxes, heatand intense light sources.

Never mix chemicals that should not be mixed together.

Clean up any spills immediately with an absorbent material (e.g.coon wool, paper towel) follow the instructions on the MSDS.

Chemical spills consider PPE and neutralizers (caustic or sol-vent).

Keep lids on containers when they are not in use.

Purchase chemicals in ready-to-use packages instead of transfer-ring from large containers.

Do not eat, drink or smoke in areas where chemicals are used orstored. Always wash hands before eating, drinking or smoking.

Ensure chemicals are disposed safely. The disposal of waste ma-terials, especially hazardous substances, via the sewerage systemimpacts on local freshwater and marine ecosystems.

Personal Protective Equipment2.3.15

Provide gloves, aprons, respiratory and eye protection to reducethe risk of exposure. In all cases, protective equipment must be ap-propriately selected, individually adapted and users trained in itscorrect use and maintenance.

Barrier creams and protective tape should be applied on exposedskin areas if bothered by skin irritation.


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A face shield or safety glasses should be worn where there is a slightchance of chemical or dust entering the eye. Wear safety glasses

over contact lenses or replace contact lenses with prescription safe-ty glasses with side protection.

Airborne Contaminants Dust,2.3.16Fumes and Vapours

Fumes, vapours and ne dust particles in the air can enter your lungs. Iftoo much dust reaches the lungs, it can overwhelm the lungs own defencesystem, causing damage to the lung tissue. Some types of dusts, such as sil-

ica, cause permanent scarring in the lungs, known as brosis. Other typesof dusts can trigger asthma aacks.

Even the larger dust particles that do not reach the lungs can cause healthproblems. Dust in the nose and in the tubes leading to the lungs can irritatethem, causing rhinitis or bronchitis.

Factors that generate dust in podiatry clinics are: grinding materials andburring nails. Liquids such as solvents release harmful vapours. Aerosolsprays release ne mist and heating materials such as thermoplastics/EVAgenerates fumes that can also be inhaled.

Controlling Exposure

If there is airborne exposure to hazardous substances, you must control

exposure so that the relevant national exposure standard for that substanceis not exceeded. Work involving hazardous substances should occur in awell-ventilated area.

Natural ventilation generally does not provide sucient airow to be suit-able for use as a method for controlling exposure to airborne contaminantsin the podiatry clinic.

Air conditioning dilutes the contaminated air rather than removing it andcirculates airborne contaminant around the room. Unless there is uniformairow, it is likely that pockets of air will remain contaminated for longperiods.


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Local exhaust ventilation is a more eective way of removing airborne con-taminants at the source, before they can be breathed in. When installing

dust/fume extraction units, care must be taken in the design of the systemto ensure that it draws contaminated air away from, rather than past a per-sons nose and mouth (breathing zone).

The breathing zone is a hemisphere of 300mm radius extending in front ofa persons face:

Replace lter bags in dust extraction units regularly.

Dusty work processes should be isolated where possible.

Good housekeeping procedures are essential. Do not use com-pressed air to remove dust from surfaces such as bench tops. Thisreleases contaminants back into the air. Clean surfaces by vacuum-ing or using wet cloths, mops or rinse items under water.

Appropriate respirators should be worn. Note that dust masks donot provide protection against chemical vapours.


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Biological Hazards Infection2.3.18Control

Please refer to the Infection Prevention and Control Guidelines for Podia-trists 2012.

Mechanical Safety2.3.19

There are various hazards which may be encountered when operatingequipment in the podiatry clinic, for example:

EQUIPMENT HAZARD

Grinder/belt sander Noise, dust, entanglement, vibration, electricalhazard

Heat guns/autoclaves Burns, electrical hazard

Podiatry chairs Falls coming onto, or o the chair

Purchase equipment with built-in safety features.

Check that all control/knobs can be operated easily.

Ensure that all tools and equipment are in good working order byconducting regular maintenance checks.

Follow manufacturers instructions and use tools and equipmentonly for the purposes for which they were designed.

Choose a suitable location to operate the equipment, providingsucient space around the equipment for it to be safely used andmaintained.

Ensure that machinery is only operated by sta trained in its use.

Where possible, provide guarding if equipment has moving parts.Hinged, clear screens should be used on grinders and belt sand-ers.

Ensure that equipment is securely anchored to the oor or benchand will not move advertently during operation.

Grinding belts, discs and burs should be used at or below the maxi-mum speed recommended by the manufacturer. Replace whenthey become worn or blunt. Know the characteristics of grinding


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and cuing tools and use only on materials for which they weredesigned.

Provide suitable gloves and/or tongs to remove hot items from ov-ens.

Eye protection and dust masks should be worn during grindingand polishing.

Electrical Safety2.3.20

Electricity is an invisible hazard and therefore it is easy to become compla-cent about electrical risks. The two major causes of electrical accidents are:

Lack of maintenance of electrical equipment

Unsafe work practices

The following control measures are necessary to ensure that risk of injuryor death from electric shock for all people at the workplace is reduced as

far as is reasonably practicable.

Electrical equipment must be either:Inspected, tested and tagged (some states require annual inspec-tions), or

Connected to a residual current device (RCD) or safety switch

Visual inspection

Conduct regular (monthly intervals at least) visual inspections of electricalequipment to check that:

Equipment (including accessories, connecting lead and plug) hasno obvious external damage or inadequate temporary repairs.

Inner cores of electrical leads are not exposed and outer coverings are not cut, frayed, worn or otherwise damaged.

Sockets are not cracked or broken.

The connection of the lead to the appliance is secure.

Control switches/knobs are undamaged and secure.


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Testing and tagging

Electrical equipment needs to be regularly inspected, tested and taggedby a qualied electrical worker. A durable, non-reusable, non-metallic tag

must be aached to the equipments exible supply cord to indicate thatthe equipment has been tested within the time prescribed in the table overpage.

Safe work practices

Ensure that workers are trained in the use of the equipment andthat manufacturers instructions are followed.

Keep electrical equipment away from wet or damp areas, unlesswaterproof electrical equipment is used.

Ensure exible leads are fully unwound and kept away from heat,chemicals, sharp edges and trac areas to prevent insulation dam-age.

When adjusting or cleaning equipment, always switch o the pow-er and pull out the plug not by the cord.

Do not touch equipment with wet hands and do not use a wet clothto clean sockets.

Do not operate too many appliances from one socket install ad-ditional power points to avoid overloading problems.

Use power boards with overload switches instead of double adap- tors.

Maintain a list of all electrical equipment and record the date ofinspection and testing, as well as details of any repairs and mainte-nance carried out.

Faulty equipment should be withdrawn immediately from serviceand have a label aached warning against further use. Arrange-ments should be made, as soon as possible, for such equipment to

be disposed, destroyed, or repaired by an authorised repair agent.

Residual current device (RCD)

Electrical equipment can be connected to an RCD, which may be eitherportable or installed at the switchboard. An RCD must be tested immedi-


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ately aer connection and at least every three months (push-buon test). Acompetent person must also test the device for operation every two years.

The use of an RCD can enhance safety but does not remove the need toobserve safe work practices and conduct regular maintenance.

Australian Standard 3760: 2001 provides frequency of inspection and test-ing recommendations.

Gas Cylinders2.3.21Many podiatry clinics use gases from portable cylinders in which the gas iscontained at high pressure, eg. cryotherapy systems, liquid nitrogen. Thehazards associated with the use of gas cylinders relate to the accidentalescape of the gas, whether in liquid or vapour form, increasing the risk ofre, explosion, asphyxiation, corrosion, cold burns or frostbite. There aremany smaller systems in use also.

Dangerous Goods classication for gases is:

Class 2.1 Flammable

Class 2.2 Non Flammable

Class 2.3 Toxic

Class 5.1 Oxidising

Obtain Material Safety Data Sheets for the gases that you are using. Checkthe requirements of Dangerous Goods legislation in your State/Territory.

Avoid the indoor use and storage of gas cylinders wherever possible. Whereit is impracticable to provide an outdoor storage and reticulation system,the keeping of cylinders is subject to the following precautions:

Use cylinders only if they are properly labelled.

Check the test date for older cylinders cylinders should be testedevery 10 years.

Protect the cylinder against falling, damage and excessive tempera-ture rise.


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Cylinders should be stored securely on a level, dry surface to pre-vent corrosion.

Store cylinders away from sources of heat and ignition, combus-tible or waste material.

Cylinder valves must be kept closed when not in use.

Store cylinders upright, ensuring that the pressure-relief device isin communication with the vapour space.

The storage area must be adequately ventilated.

Do not store cylinders in locations that may jeopardise escape from a building in the event of re.

Where a cylinder is designed to incorporate a detachable valve cap,the cap should be kept in place when the cylinder is not in use.

Whenever possible use a cylinder trolley for transporting large cyl-inders.

Never let oil or grease contact your cylinder or ings, especially

oxygen equipment.Regularly check hoses, connections, valves and pressure regulatorsfor faults and leaks. Test for leaks using soapy water.

Where cylinders are used or located indoors, the total capacityshould not exceed two 9kg cylinders, which includes cylinders inuse, spare cylinders not in use and empty cylinders awaiting re-moval.

References:Australian StandardsAS 4332: 1995 The storage and handling of gases in cylindersAS/NZS 1596: 2002 The storage and handling of LP Gas

Fire Safety2.3.22

Prevent res by following safe work practices:

Dont allow rubbish to accumulate.Use Australian Standards approved safety cans for carrying orpouring ammable liquids.

Store and use ammable liquids in a well ventilated area away fromignition sources.


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Avoid storing large quantities of ammable substances.

Ensure electrical leads and appliances are in good working order.

Never overload circuits.

Prevent leaks and spills of ammable gases and liquids.

Be well prepared in the event of a re:

Ensure all exits are marked and kept clear of obstacles.

Install smoke alarms and sprinkler systems.

Ensure that you have appropriate re extinguishers. Each build-ing and premises with in it needs a re evacuation plan placed in apublic place, with exit points and an evacuation route/ safe meetingpoint marked. There needs to be a person allocated to monitor there extinguisher maintenance at least 6 monthly and that trainingis done for all users of the premises annually.

Location of Portable Fire Extinguishers:

Each extinguisher should be located in a conspicuous and readily acces-sible position. Where practicable, extinguishers should be located alongnormal paths of travel and near exists.

For non-domestic installations, extinguishers in and around buildingsshall:

have their locations clearly identied with an appropriate sign.a.hps://www.re.qld.gov.au/planning/.

be mounted at the appropriate height and the extinguisher, or ex-b.tinguisher location sign, shall be clearly visible from a distance upto 15m in all directions of approach.

Type of Fire Extinguisher:

There is no one type of re extinguisher that will universally cover allclasses of res. Therefore careful consideration must be given to all factorslikely to cause res in order to select the most suitable re extinguisher, orcombination of re extinguishers.
https://www.fire.qld.gov.au/planning/https://www.fire.qld.gov.au/planning/


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The following lists the various types of re classications:

Class A - Fire involving carbonaceous solids, such as wood, cloth,paper, rubber and many plastics

Class B - Fires involving ammable and combustible liquids

Class C - Fires involving combustible gases

Class D - Electrical Hazards

Electrical Hazards

Where a re is due to an electrical hazard can be expected, the extinguish-er must be electrically non-conductive, in addition to having the relevantclassication. The marking of [E] on the re extinguisher indicates that it issuitable for use on res involving live electrical equipment.

NOTE: Extinguishers produced between 1976 and 1981 were marked [C] to

indicate electrical non-conductivity.

Gas Hazards

A oor plan displayed near the entrance to the clinic should also indicatethe location of gas cylinders. Dierent gases should be stored separately.

Factors which aect the selection of re extinguishers include:

Choice of an appropriate extinguisher for the type of re most like-a.ly to occur.

Size and mass of the re extinguisher and the ability of the user tob.carry and operate it.

Eects of environmental conditions on the re extinguisher and itsc.

support xture.Possibility of adverse reactions, contamination and other eects ofd.an extinguisher on products or equipment.

Possibility of winds or draughts aecting the distribution of the ex-e.tinguisher.


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Maintenance: Maintenance should be carried out every six (6) months inaccordance with Australian Standards 1851.1.

WHAT TO DO WHEN A FIRE STARTSIf there is no danger, assist any person/s in immediate danger.

Close the door.

Call the Fire Brigade on triple zero, 000.

Aack re if SAFE to do so.

Evacuate to assembly area.

Remain at assembly area and ensure everybody is accounted for.

Never place a used extinguisher back on its hook or bracket.

Noise and Vibration2.3.23

Noise

Various processes and equipment in podiatry clinics emit noise. Besidesthe risk of hearing loss, exposure to high or continuous levels of noise canalso result in fatigue and distraction. Noise is a problem if it is dicult tohear a normal voice within a distance of one metre.

The current noise exposure standard sets a limit of 85 dB(A) for exposureto an 8 hour equivalent continuous sound pressure level. For impulsive

noise, the existing peak noise standard is 140 dB. Three elements whichneed to be considered in controlling noise are:

Noise sourceNoise pathNoise receiver

Control noise at the source:1.

New equipment usually has lower noise levels than older ver-

sions.Regularly lubricating and servicing equipment will also reduce thenoise level.


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Isolate the noise:2.

Place noisy equipment, such as a belt sander, in another room or

enclose the unit in a soundproof box.

Rearrange the layout of the workplace to separate noisy work ac-tivities from quieter activities.

Protect the worker:3.

If exposure is still excessive aer all possible control measures havebeen taken, individual protection in the form of earmus or ear-

plugs should be used.

Vibration

Podiatrists are exposed to hand vibration when holding a work pieceagainst a moving tool, such as a grinding wheel or when using a hand drillto burr nails.

The most common condition caused by prolonged exposure to high levelsof local vibration is vibration white nger or Raynauds disease. Initialsymptoms are slight tingling and numbness. Later the tips of ngers haveaacks of whiteness and are painful; with continued exposure to vibra-tion the ngers turn permanently blue-black, sometimes with the adventof skin necrosis.

Precautions

The most dangerous frequencies appear to be between 40 Hz and 120 Hz.Disabilities from hand vibration are signicantly increased when the op-erators hands are cold.

Reduce vibration by:

Using insulating covers on hand tools.

Replacing old equipment with new equipment that has less vibra-tion.

Regularly servicing machinery.


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Mounting machinery on a heavy base.

Care should be taken when using an ultrasonic cleaner. Fingers

should never be placed into the unit while it is operating.

Work Environment2.3.24

Construction of Premises

It is recognised that not all existing clinic premises are designed to meetcurrent standards, however if businesses renovate, relocate or if you areopening a new businesses - these standards should be met.

Planning for new construction or major renovation requires early and con-tinuous consultation between architects, engineers, government authori-ties and trade persons all of whom are familiar with the requirements ofthe podiatry industry, to ensure compliance with workplace health and

safety legislation. Consult other clinics to ascertain what problems, if any,they encountered.

Workplace health and safety and infection control issues must be consid-ered at all stages of the design and construction of new premises. Accessand egress, the texture of ooring, height and positioning of sinks/basins,

benches and switches must all be taken into account during the designphase as they may be dicult and or expensive to rectify aer completionof the works. Work practices during and aer construction of the premiseor facility must incorporate workplace health and safety principles.

Additional Resources

Building Code of Australia

The Australian Commission on Quality and Safety in Health CareStandards (2011), and

Relevant Australian Standards such as AS 4187 - 2003 Cleaning,disinfecting and sterilising reusable medical and surgical applianc-es and equipment, and maintenance of associated environments inhealth care facilities


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Floor Surfaces

Uneven or slippery oors hinder smooth movement, make oor surfacesunpredictable and increase the likelihood of slips, trips and falls. The pres-ence of steps, changes of oor coverings, etc can also increase the risk ofinjury.

Measures to reduce the risk of injury from inadequate oor surfaces in-clude:

Using non-slip surfaces. This does not have to be expensive. How-ever, the use of carpet in the clinic area is not recommended as itcontravenes infection control standards.

Wearing shoes with low heels, non-slip soles and which encloseand support the whole foot.

Spillage of water, oil, chemicals and other substances is common on

oors and should be removed as soon as possible.

Lighting

Poor lighting can adversely aect safety and can contribute to:

Accidents and injuries

tired, sore eyes

headaches

blurred vision

Common lighting problems include too much or too lile light. Glare andshadows can force the worker to use awkward body positions to see work.Poor lighting conditions can increase the risk of injury. For example, going

from areas of bright light to shadow can temporarily impair vision andincrease the risk of tripping. A good lighting system eliminates shadows,and highlights potential hazards.

Natural or articial light needs to be at appropriate levels for the task.Some activities will require lamps to provide adequate light on the work


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area. Eective lighting includes:

Illuminating the complete work area using daylight type uores-cent tubes.

Light intensity of 3000 lux to see very ne detail.

Prismatic covers over the uorescent tubes will eliminate harshshadows or glare.

replacing bulbs or tubes as they age and lose light emiing capac-ity.

Keeping light covers and windows c lean.

Providing blinds, curtains or window tinting to control glare.

Air Quality

Air quality is inuenced by:

Temperature in an air-conditioned workplace, the ideal tempera-ture range is between 19-23C in winter and 22-24C in summer.

Humidity relative humidity levels should ideally be between 40%and 60%.

Air movement too lile airow may create stuy indoor environ-ments whereas too much air movement causes draughts. An air-ow rate of between 0.1 and 0.2 metres per second is ideal.

Air contaminants exposure to hazardous dust, fumes and va-pours may cause a range of health eects such as headaches, eyeirritation and respiratory conditions. Regulations vary from state tostate re: smoking in the workplace: see hp://www.ashaust.org.au/SF%2703/law.htm, generally there is a 4 m exclusion zone aroundentrances to the workplace.
http://www.ashaust.org.au/SF%2703/law.htmhttp://www.ashaust.org.au/SF%2703/law.htmhttp://www.ashaust.org.au/SF%2703/law.htmhttp://www.ashaust.org.au/SF%2703/law.htm


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Common causes of air problems

Air-conditioning systems

Design

Operation

Maintenance

Examples

Inadequate cooling capacity

Not turned on before occupants arrive

Filters not changed

Building materialNew

Damaged

Paint, fabric, carpet - releasing pollutants

Mould on water-damaged carpet

Work activitiesGrinding, polishing

Using chemicals

Using ovens

Dust

Chemical vapours, odours

Heat producing

People Smoking

Body odour

Perfumes

Outdoor airEntering through air-conditioning systemsand through openwindows/doors

Exhaust fumes, dust, pollens

Air-conditioning systems can provide a comfortable indoor environmentin terms of air temperature, humidity and air-movement. If an air-condi-tioning system is installed, it should operate whenever people are in theworkplace. Air -conditioning systems need to have air lters cleaned andmonitored at least every 3 months. Systems which operate by automatictimer should have an override facility if people are required to use the

building out of normal work hours. The following factors need to be con-sidered in assessing the thermal environment:

Eect of solar heat (sun shining through window) and heat sourcesinside the laboratory (furnaces)

Clothing worn by workers, including protective clothing

Nature of the work being performed


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Individual perceptions of thermal comfort

Ways to control thermal comfort

If an air-conditioning system is installed, adjust temperature andhumidity.

Avoid locating workstations directly in front of or below air-con-ditioning vents to prevent sta being aected by draughts. Installdeectors on air vents to direct airow away from people.

Shield windows using reective glass, blinds or awnings.

Relocate workstations away from heat sources.

First Aid2.3.25

In addition to being a legal requirement, workplace rst aid:Saves lives/reduces the severity of injuries.

Reduces pain and anxiety.

Reduces the cost of injuries.

Contributes to a safer workplace.

To determine adequate rst aid provisions, list the types of injury and ill-ness that could occur in your workplace and their potential causes. Con-sider the size and layout of the workplace as well as the number of sta.Also include rst aid requirements for patients and visitors be aware ofany medical conditions and special needs.

All podiatrists are required to hold a current CPR Certicate which mustbe renewed according to the course providers certication on the term of

currency.

Requirements for First Aid Kits

Contents will depend on your workplace hazards and the types of injury/

illness likely to occur. Quantity of items may depend on the size of theclinic. Basic First Aid kits should include the following:

Adhesive plastic dressing strips, sterile, pkt of 50 Dressing, non ad-herent sterile 7.5cmx7.5cm Gloves, disposable single


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Safety pins, packet

Gauze bandages 50 mm, 100 mm

Swabs, packet of 10, pre-packed, antiseptic Triangular bandages

Antiseptic 50ml Savlon or equivalent

Scissors, blunt, short nosed, min. length 12.5 cm

Eye pads, sterile

Resuscitation masks/bags

Rescue Blanket

Adhesive dressing tape 2.5 cm x 5 m

Sterile eyewash solution, 10ml single use

Ampoule

Kidney dish

Wound dressing No. 14

Splinter forceps, stainless steel

Number of kits at least one rst aid kit should be provided for eachworkplace. If necessary, consider locating a central rst aid kit in thelaboratory and a smaller kit in the clinic.

Location of kits close to areas where there is a likely risk of injury/

illness occurring. They should be clearly visible and easily accessible.First aid kits should be provided for persons working in remote areasor in vehicles where access to medical and emergency services may belimited.

Signs the following symbol should be displayed on the outside of therst aid kit:

First Aid Symbol white cross on green background


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Information a list of contents should be provided with the kit. Namesof trained rst aiders should also be displayed with important tele-

phone numbers, including 000.Management the trained rst aider should be responsible for assess-ing kit requirements, checking and restocking contents and ensuringkits are accessible and not locked whenever sta are at work.

First Aid Awareness2.3.26

All sta should be given information about:

The type of rst aid facilities in the workplace

The location of rst aid kits

The names and work phone numbers of person/s responsible forrendering rst aid

The procedures to be followed when rst aid is required

Recording of Injuries2.3.27

First aid record systems should be integrated with other incident and acci-dent reporting systems, in particular with the Register of Injuries required

by workers compensation laws. The rst aid report form should be com-pleted by the trained rst aider and include information on:

Name of injured person

Date and time

Description of symptoms

Treatment provided

Any referral arrangements (e.g. ambulance, hospital, medical ser-vice)

Remember to keep personal information about the health of an employee

or patient condential.

Any patient injury should be reported to your professional indemnity in-surer to ensure future claims arising from the injury are covered.


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Domiciliary2.3.28

The podiatrist should ensure at all times when carrying equipment into thepatients home that:

Correct back posture is maintained whilst liing.

Not too many items are aempted to be carried inside at once (mul-tiple trips are beer than overloading one trip).

Only equipment that is necessary should be taken into the home.

It is advisable that the podiatrist does not treat in any one position fora prolonged period, particularly if unnatural such as siing on the oor.Regular breaks to stretch the back are recommended and treatment posi-tions should be altered oen.

Allow enough time to pack/unpack the car, arrange furniture at the homeof the patient to provide the best possible treatment seing, conduct thetreatment, pack equipment, write up the patient history and make a follow

up appointment. Be realistic about the number of patients it is possible totreat in a day (on average, one per hour- depending on travel time).

ACT workcover. Please go to web address:1. hp://www.worksafe.act.gov.au/health_safety

ACT WorkCover Small Business Health and Safety Toolkit, 20002.

ACT Dept. of Health, Housing and

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