Device Cleaning and Infection Control in Aerosol Therapy

Abstract

Aerosol delivery equipment used to administer inhaled medications includes the nebulizer, positive expiratory pressure devices added to the nebulizer, and valved holding chambers (spacers). These devices are semi-critical medical devices, and as such, infection prevention and control (IPC) guidelines recommend that they be cleaned, disinfected, rinsed with sterile water, and air-dried. There is confusion surrounding the care of aerosol devices because of inconsistencies in the various published IPC guidelines, lack of a standard of practice among institutions and respiratory therapists (RTs), and manufacturer's instructions for use of these devices are not always compatible with guidelines or practice. Challenges lie in awareness of IPC guidelines and establishing a standard for the care of aerosol delivery devices among all stakeholders/manufacturers, governments, vendors, and users. The latest IPC guideline from the Cystic Fibrosis Foundation, reviewed and endorsed by the Society for Healthcare Epidemiology of America and the Association for Professionals in Infection Control, has a recommendation for disposable nebulizers and a recommendation for reusable nebulizers. Reusable nebulizers should be cleaned, disinfected, rinsed with sterile water (if using a cold disinfectant), and air-dried between uses. The mouthpiece/mask of disposable nebulizers should be wiped with an alcohol pad, the residual volume should be rinsed out with sterile water after use, and the nebulizer should be replaced every 24 h. The RT plays a significant and responsible role in providing and teaching aerosol therapy to patients. The RT and all stakeholders need to work together to provide a standard of care for the safe use of aerosol delivery devices.

Results of a Pulmonologist Survey Regarding Knowledge and Practices With Inhalation Devices for COPD

“…34 The recommendation for home nebulizers is to clean, disinfect, rinse (if needed), and air dry after each use. 35 There seemed to be a significant knowledge gap among the pulmonologists in this survey, with only approximately 70% who responded that device decontamination was absolutely essential or very important (data not shown). As many as 60% of the respondents believed that they did not have adequate knowledge about the cleaning and maintenance of SVNs, and only 9% of the respondents discussed cleaning and storage of the inhalation devices with their patients during their first visit.…”

Vibrating Mesh Nebulizer Compared With Metered-Dose Inhaler in Mechanically Ventilated Subjects

“…5 Cost savings may also be found with the use of a common canister protocol with mechanically ventilated patients without increasing the risk of cross-contamination. 6 There are additional factors affecting aerosol delivery in mechanically ventilated patients. The presence of the artificial airway alone can significantly reduce the efficiency of an aerosol delivery device.…”

Evaluation of the Effectiveness of two Different Methods for the Prevention of Microbial Colonization in Nebulizers: Randomised Control Trial

“…Delivery of drugs using nebulizer is preferred because of the local and rapid effect, and fewer side effects with lower doses. The risk of infection, overdose or adverse effects during delibvery of the drugs are the disadvantages of the use of a nebulizer (2) .…”