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Help homeless priotise hygienic foot care, urges QNI guidance

The Queen's Nursing Institute (QNI) has issued guidance on how community nurses can help homeless people with foot care, including medication, checks and referral, and named hygiene as the top priority.

The latest government street counts and estimates suggest around 2,744 people slept rough every night in 2014 in England, a rise of 55% since 2010. However, "the actually figures are likely to be much higher" the charity Crisis said in a recent briefing.

The average age of death for a homeless person is just 47 and homeless people "experience very poor health outcomes", the charity said. "Promote hygiene as the first priority," QNI said, and recommends nurses advise baby wipes or find out about local facilities where homeless people can wash, in order to refer them appropriately.

Provide immediate antibiotic cover for someone with a diabetic ulcer injury, as "it may be several days before they present themselves and infection may infiltrate the bone if not caught quickly". Swab the feet as more complex bacteraemia and gangrene can be found in people who are homeless, and try to palpitate pedal pulses and assess for neuropathy or peripheral vascular disease and treat minor injuries with a topical antiseptic cream.

Homeless patients should dry feet well to prevent recurrent infection, especially between the toes, and advised not to use knives to cut toenails and visually check feet daily for minor injuries.

In terms of seasonal issues, in the winter homeless patients should keep feet warm as best they can, wear socks with natural fibres or cushioning such as diabetic socks, and try to clean them daily.

Tell the patient what to expect if feet or toes become frostbitten as the skin thaws. If the skin turns red and the person feels tingling and burning as it warms then normal blood flow is returning, however if numbness or pain occurs or blisters develop then emergency treatment is needed, the guidance said.

See the full guidance here.