Recommendations for hygiene of masks and circuits in mechanically home ventilated patients

Abstract

Home mechanical ventilation requires equipment, consisting of a generator of pressure, a tubing and an interface to deliver air to the patient. Instructions for equipment maintenance are generally not based on scientifi c evidence. Studies however have reported that tubing and masks used at home are the most commonly found as very dirty and contaminated. Dirtiness and contamination of equipment potentially expose patients to a higher risk of airway colonization, which, in turn, should cause respiratory infections. For this reason, published hygiene instructions include the use of disinfectant solution. Nevertheless, they generally fail to explain how basic maintenance may be achieved by simple cleaning with soap and water. The instructions for post-cleaning disinfection will depend upon the relative sensitivity of patients to respiratory tract infections and the related risks for bacterial colonization of the airways. Restrictive and obstructive disease patients are not equally sensitive to infections and, as a consequence, should not require similarly elaborate disinfection level. According with the restrictive or obstructive origin of respiratory insuffi ciency, the current educational review suggests simple and adequate rules for hygiene of tubing and masks in the home setting. Written instructions on how to clean the equipment for home ventilation are useful and suffi cient in restrictive patients. In obstructive patients, cleaning always precedes disinfection. After cleaning, rinsing and drying are important. An effective weekly 20-minute disinfection may be achieved by using an hypochlorite solution of soaking in a concentration of 0.5%.

Survey of Home Cleaning Practices With Noninvasive Ventilation Equipment

“…One fifth of participants also reported using only water to clean their tubing, machines, and humidifier chambers, whereas almost 2 fifths reported using a dry cloth to clean their machine surfaces. The use of detergent is recommended 2,6,22 as it reduces pathogen infectivity by disrupting microbial cell membranes. Excluding detergent during cleaning can, therefore, potentially reduce the effectiveness of microbe removal from NIV equipment.…”

“…However, recommendations vary between different manufacturers and are often not evidence-based. 6 Few studies have investigated contamination of home NIV equipment. Tubing and masks have been found to be colonized by potentially pathogenic bacteria and fungus.…”