Bacterial Contamination of Aerosols

Pierce, Alan K.

doi:10.1001/archinte.1973.00320070152017

Cited by 47 publications

(15 citation statements)

References 37 publications

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“…Investigators during the 1960s and early 1970s demonstrated that contaminated respiratory therapy (RT) equipment was a potential and actual infectious disease hazard in hospitals (7,8,(16)(17)(18). In 1978, we investigated RT equipment in several hospitals and noted that approximately 35 to 45% of the nebulizers and large reservoir wall humidifiers were contaminated with microorganisms (19).…”

mentioning

confidence: 99%

Direct dilution sampling, quantitation, and microbial assessment of open-system ventilation circuits in intensive care units

Malecka-Griggs¹,

Reinhardt²

1983

J Clin Microbiol

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In a systematic approach, 37 duplicate samples of open system circuits (Bennett MA-1 ventilators) of patients in medical and surgical intensive care units were processed by direct and serial (APHA guidelines) dilutions. The paired difference test on 15 of the in-use circuitry solution samples indicated no difference between the direct and serial dilution methods (P < 0.001). Seventy-seven additional respiratory therapy circuitry samples from similar intensive care patients were analyzed via a direct dilution method alone and processed microbiologically. The direct dilution procedure was a rapid and accurate means of evaluation of microbial contamination in the range of .10 to s106 CFU/ml. High densities of organisms frequently were found. Sites of contamination included the proximal or patient end of the circuitry (heaviest), the nebulizer trap, and the distal or humidifier portions of the circuitry. The contaminants found were predominantly gram-negative nonfermenters: Acinetobacter calcoaceticus var. antitratus, Pseudomonas aeruginosa, Pseudomonas maltophilia, and Flavobacterium meningosepticum. Fermenters were Klebsiella pneumoniae, Proteus sp., Enterobacter cloacae, Citrobacter diversus, and Enterobacter agglomerans. Infrequently, gram-positive Streptococcus spp. and Staphylococcus spp. were noted.

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mentioning

confidence: 99%

Direct dilution sampling, quantitation, and microbial assessment of open-system ventilation circuits in intensive care units

Malecka-Griggs¹,

Reinhardt²

1983

J Clin Microbiol

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“…The inoculated Serratia marcescens used by Nazemi et al was regularly detected in aerosols when >-10 CFU per ml was present in reservoirs. Pierce and Sanford (22) noted that when reservoir fluids were free of bacteria, the effluent gas was not contaminated. Reinarz and co-workers (23) observed a correlation between microbial numbers in air samples obtained by an Anderson air sampler and the numbers of microbes in the reservoirs assayed by standard dilution analyses.…”

Section: Resultsmentioning

confidence: 99%

“…During the period of 1966 to 1973, Edmondson, Mays, Pierce, Reinarz, and Sanford documented the nature and extent of bacterial contamination of nebulizing respiratory therapy (RT) equipment in some hospitals in Texas (5,6,22,23). These investigators noted a clear and direct relationship between the incidence of gram-negative necrotizing pneumonia and the incidence of contaminated nebulizing devices.…”

mentioning

confidence: 99%

Limulus amoebocyte lysate and direct sampling methods for surveillance of operating nebulizers

Reinhardt¹,

Nabors²,

Kennedy³

et al. 1981

Appl Environ Microbiol

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The Limulus amoebocyte lysate test for detection of endotoxin (Pyrogent; Mallinckrodt Chemical Co.) and the Easicult method (Orion Diagnostica) for detection of bacteria were compared with direct dilution sampling, a standardized technique for respiratory therapy surveillance previously developed in our laboratory. Tests of 206 reservoirs of nebulizers were done in three hospitals in Georgia. Forty-five percent of all reservoirs sampled were contaminated. Gramnegative, nonfermentative bacilli were the predominant contaminants. The results of the Limulus test and the Easicult system were in agreement with those of the direct dilution sampling tests approximately 84 and 90% of the time, respectively. Direct dilution of water samples onto blood agar plates was the most sensitive, reliable, and informative method for detecting viable bacteria. The Easicult and Limulus systems were sensitive enough to detect _103 colony-forming units per ml. Positive Limulus tests and negative culture tests, reflecting detection of endotoxin but not of viable gram-negative bacteria, occurred in 20 of 206 (9.7%) instances. Positive cultures and negative Limulus tests were noted in 13 of 206 (6.8%) samplings. The Limulus test is a valuable procedure, for it can detect moderate-to-heavy microbial contamination within 1 h of testing and affords the opportunity to remove contaminated equipment from patients within minutes of a positive test result. These results demonstrate the potential value of the Easicult and Limulus tests for selective surveillance of operating nebulizers.

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“…Several studies have linked the use of humidifying devices and inhalation therapy equipment to respiratory tract colonization and infection (3–8). In one study 61% of domiciliary nebulizer solutions and/or aerosols were contaminated with gram‐negative bacilli (75%), gram‐positive organisms (10%), or Candida species (15%) (9).…”

Section: Discussionmentioning

confidence: 99%

Mycobacterium gordonae pulmonary disease associated with a continuous positive airway pressure device

Assi

Berg²,

Marshall

et al. 2007

Transplant Infectious Dis

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Bacterial Contamination of Aerosols

Cited by 47 publications

References 37 publications

Direct dilution sampling, quantitation, and microbial assessment of open-system ventilation circuits in intensive care units

Direct dilution sampling, quantitation, and microbial assessment of open-system ventilation circuits in intensive care units

Limulus amoebocyte lysate and direct sampling methods for surveillance of operating nebulizers

Mycobacterium gordonae pulmonary disease associated with a continuous positive airway pressure device

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