Lesson 1 covered which tools to use; Lesson 2 covered how to reprocess them. This reference page covers the workflow that connects the two: how to prepare your point-of-care setup so the right tools are ready, the field stays clean, contaminated items don't cross-contaminate clean ones, and the visit is properly documented. This applies to both clinic-based and home/community visits.
Pre-Visit Setup Checklist
Run through this before every patient. The goal is that everything you need is in place before the patient sits down — no rummaging mid-procedure with contaminated gloves.
Before the patient arrives
Standard pre-visit setup
1
Disinfect the work surface and treatment chairEPA-registered hospital-grade disinfectant per facility policy. Allow full contact time per the manufacturer's IFU before placing items down.
2
Place a clean barrier (drape or single-use pad)Provides a defined clean field. Replace between patients even if no visible contamination.
3
Open sterilized instruments at point of usePouches stay sealed until the patient is ready. Check the chemical indicator strip before opening — if the indicator hasn't changed, the contents are not sterile and must be reprocessed.
4
Position single-use items within reachDisposable files, gauze, gloves (extra pairs), emollient, sharps container, biohazard bag. Set up so you can reach them without crossing over the clean field.
5
Sharps container at point of useWithin arm's reach of the working hand. Never carry sharp instruments across a room to dispose of them — that's how needlestick injuries happen.
6
Hand hygiene immediately before patient contactEven if you washed when you arrived. WHO Moment 1: before touching the patient.
Standard Tray Layout
A consistent layout reduces errors, prevents cross-contamination, and means staff can find what they need without thinking. The principle: clean items on one side, working area in the middle, contaminated items on the opposite side.
Foot care instrument tray — recommended layout
Clean items left · Active work center · Contaminated right
1
Sterile nippersIn sealed pouch with intact chemical indicator
2
Sterile metal fileSame — sealed pouch, indicator verified
Clean barrierSingle-use drape, replaced every patient
6
Hand sanitizerFor glove changes and WHO Moments
7
Sharps containerWithin arm's reach; never recap or carry
8
Biohazard bagFor contaminated disposables
9
Used instrument trayFor transport to reprocessing
The Three-Zone Principle
Whether your workspace is a clinic treatment room or a kitchen table during a home visit, the same principle applies: divide it into clean, work, and dirty zones. Items move one direction only — from clean → work → dirty. Nothing moves back.
✨
Clean Zone
Pre-procedure
Sealed sterile instruments
Unopened disposables
Extra gloves and PPE
Items not yet contacted
🛠️
Work Zone
Active procedure
Clean barrier in place
Active instruments
Hand sanitizer at hand
Patient's foot positioned
🚫
Dirty Zone
Post-procedure
Sharps container
Biohazard waste bag
Used instrument tray
Soiled drapes/gauze
💡
One-way flow
Items only move toward the dirty zone, never away from it. A used instrument never returns to the clean zone — it goes directly to the used-instrument tray for transport to reprocessing. Likewise, sterile pouches don't get opened in the dirty zone. This sounds obvious until a busy day, when "I'll just put this here for a sec" becomes a contamination event.
Home and Community Visit Considerations
🏠 Mobile foot care nursing
Adapting infection control to home and community settings
Many foot care nurses work in patient homes, assisted living, long-term care, and community settings rather than fixed clinics. The infection control standards don't change — but the practical execution does. The same Spaulding classification applies; what changes is logistics.
Reprocessing
Autoclaving happens off-site (back at the clinic or via a sterilization service). Transport contaminated instruments in a sealed, leak-proof, biohazard-labeled container. Never reuse instruments between patients on the same visit day — bring a separately reprocessed set for each patient.
The mobile kit
One sterile-instrument set per patient, sealed in pouches. Single-use disposables (files, pumice, gauze, emollient). PPE. Portable sharps container. Sealed biohazard bags. Hand sanitizer. EPA-registered surface disinfectant wipes.
Surface prep
You won't have a clinical treatment chair. Wipe down whatever surface you use (kitchen table, recliner side table) with hospital-grade disinfectant; place a clean barrier; set up your three zones on top of the barrier.
Sharps disposal
Carry a portable, FDA-cleared sharps container with you. Never use a household container. Transport sealed sharps containers to the clinic or designated disposal facility — household trash is not appropriate disposal even in home settings.
⚠️
The "I only have one set" problem
Some mobile foot care nurses try to economize by carrying one instrument set and reprocessing in the patient's home (e.g., wiping with disinfectant between patients). This does not meet the Spaulding standard for critical instruments. The minimum acceptable practice is one fully sterilized set per patient. If volume requires it, carry multiple sets or schedule patients with adequate time for full off-site reprocessing between visits.
Documentation Requirements
Documentation serves three purposes: clinical continuity, infection control accountability, and legal/regulatory compliance. For accredited foot care nursing programs and for OSHA/AAMI compliance, the following items should be in the record.
What to document
Detail
Patient consent
Verbal or written consent for the procedure, with any specific concerns or limitations noted.
Pre-visit assessment
Skin and nail status, vascular and sensation findings (per Module 2 hands-on assessment), diabetic foot risk category if applicable, current medications relevant to foot care.
Instruments used
Type and identifier of each reusable instrument used (e.g., "set #4 — autoclaved 03/15, indicator verified"). Single-use items used.
Procedure performed
Specific interventions: nail trimming technique, callus reduction method, any other treatment. Patient response and tolerance.
Post-visit findings
Skin integrity confirmed at end of visit, any bleeding or breaks noted and addressed, recommendations and patient education provided.
Sterilization log (separately)
Per ANSI/AAMI ST79: every autoclave cycle logged with date, contents, parameters, chemical indicator result, biological indicator result (weekly minimum). Retain for the period required by your state and facility.
Exposure events
Any sharps injury, splash, or other exposure: date, time, mechanism, source patient, immediate actions taken, follow-up plan. Per OSHA 29 CFR 1910.1030 — required record.
Follow-up plan
Next visit interval, any referrals made, escalation indicators if patient calls between visits.
📝
If it isn't documented, it didn't happen
This is the standard refrain in nursing — but for foot care it has specific weight. Sterilization logs are the legal record proving instruments were properly reprocessed. A patient who develops an infection three weeks after a visit will be asked: was the instrument sterilized? Your log answers that question. No log = no proof.
Educational Disclaimer
The information on this website and any communication with RNscrub Foot Care is provided for educational and informational purposes only. It is not a substitute for medical advice, diagnosis, or treatment. Patients are always encouraged to consult with their primary care provider or appropriate specialist for individual clinical decisions.
References
Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities. 2008 (updated periodically).
Association for the Advancement of Medical Instrumentation. ANSI/AAMI ST79: Comprehensive guide to steam sterilization and sterility assurance in health care facilities. 2017.
Occupational Safety and Health Administration. Bloodborne Pathogens Standard. 29 CFR 1910.1030.
World Health Organization. Guidelines on Hand Hygiene in Health Care. 2009. (Source of the WHO 5 Moments for Hand Hygiene framework.)
U.S. Food and Drug Administration. Sharps Disposal Containers. (Regulatory guidance for FDA-cleared portable sharps containers.)
U.S. Environmental Protection Agency. List N: Disinfectants for Use Against Pathogens. (Hospital-grade disinfectant registration list.)
