Long-Term Evaluation of Decontamination of Inhalation-Therapy Equipment and the Occurrence of Necrotizing Pneumonia

Pierce, Alan K.; Sanford, Jay P.; Thomas, Grace D.; Leonard, J. S.

doi:10.1056/nejm197003052821002

Cited by 133 publications

(3 citation statements)

References 24 publications

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“…Pathogens can enter the lower respiratory tract through the inhalation of aerosols generated by contaminated respiratory-therapy equipment 22,23 . Nosocomial infections (e.g., hospital-acquired pneumonia [HAP], healthcare-associated pneumonia [HCAP]) are some of the most serious patient safety issues facing the healthcare system today 24 .…”

Section: Cross-contamination Riskmentioning

confidence: 99%

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

Larson

Gudavalli

Prater

et al. 2015

Current Medical Research and Opinion

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Respiratory inhalers constitute a large percentage of hospital pharmacy expenditures. Metered-dose inhaler (MDI) canisters usually contain enough medication to last 2 to 4 weeks, while the average hospital stay for acute hospitalizations of respiratory illnesses is only 4-5 days. Hospital pharmacies are often unable to operationalize relabeling of inhalers at discharge to meet regulatory requirements. This dilemma produces drug wastage. The common canister (CC) approach is a method some hospitals implemented in an effort to minimize the costs associated with this issue. The CC program uses a shared inhaler, an individual one-way valve holding chamber, and a cleaning protocol. This approach has been the subject of considerable controversy. Proponents of the CC approach reported considerable cost savings to their institutions. Opponents of the CC approach are not convinced the benefits outweigh even a minimal risk of cross-contamination since adherence to protocols for hand washing and disinfection of the MDI device cannot be guaranteed to be 100% (pathogens from contaminated devices can enter the respiratory tract through inhalation). Other cost containment strategies, such as unit dose nebulizers, may be useful to realize similar reductions in pharmacy drug costs while minimizing the risks of nosocomial infections and their associated medical costs. The CC strategy may be appropriate for some hospital pharmacies that face budget constraints, but a full evaluation of the risks, benefits, and potential costs should guide those who make hospital policy decisions.

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Section: Cross-contamination Riskmentioning

confidence: 99%

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

Larson

Gudavalli

Prater

et al. 2015

Current Medical Research and Opinion

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“…Hier waren kontaminierte Vernebler, zur Befeuchtung der Beatmungsgase eingesetzt, wiederholt die Ursache für schwere nekrotisierende Pneumonien [60]. Typische Feuchtkeime wie Pseudomonas aeruginosa können sich im Verneblerwasser vermehren und werden dann zusammen mit den 1-3 µm großen Wassertröpfchen in die Lunge transportiert.…”

Section: Pneumonieprävention Durch Sdd Pathogenese Beatmungsassoziierunclassified

Selektive Darmdekontamination in der Intensivmedizin

2003

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Selective digestive tract decontamination (SDD) is a method where topical non-absorbable antibiotics are applied to the oropharynx and stomach which primarily is aimed at the prevention of ventilator-associated pneumonia. The rationale for SDD is that ventilator associated pneumonia usually originates from the patients'own oropharyngeal microflora. SDD is also used for the prevention of gut-derived infections in acute necrotizing pancreatitis and in liver transplantation. Despite numerous clinical trials and several meta-analyses, SDD is still a controversial topic. It is now commonly accepted that the incidence of pneumonia is reduced,however, the concept of using topical antibiotics has its inherent limitations and the best results have been obtained by combination with a short course of intravenous antibiotics. Several issues surrounding the notorious difficulties in establishing the diagnosis of ventilator-associated pneumonia especially in the presence of antibiotics are an on-going matter of debate.Furthermore, pneumonia is the leading cause of death from nosocomial infections and its prevention was not adequately followed by reduced mortality in most individual trials, however, a benefit was suggested by recalculation of data in meta-analyses. Patients are not well defined by their need for ICU admission and mechanical ventilation and the attributable mortality of infections depends more on the type and severity of the underlying diseases. Recently published trials substantially improved our understanding as to which patients may derive most benefit from SDD.Currently, it seems that an improved survival can be achieved in surgical and trauma patients with severe but salvageable diseases, which might be classified e.g.by calculation of APACHE-II scores on admission.However, the most important drawback of SDD is the development of resistance and an increased selection pressure towards Gram-positive pathogens, especially in institutions with endemic multi-resistant microorganisms.Thus, it appears that "selective" must not only be interpreted as selective suppression of pathogenic bacteria but rather as selection of appropriate groups of patients with respect to underlying diseases and severity of illness. Furthermore, it means selection of ICUs where the endemic resistance patterns might allow the use of SDD at a relatively low risk for selection of resistant microorganisms, which is still the major concern associated with SDD.

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“…84 In vitro results may not be applicable to actual in-use situations. Pierce et al 64 reported that a 2% glutaraldehyde solution failed to disinfect ultrasonic nebulizers heavily contaminated with Pseudomonas sp. Carson et al 10 compared the resistances of naturally occurring and subcultured cells of a strain of P. aeruginosa to glutaraldehyde and found that the naturally occurring organisms were the more resistant and cautioned against extrapolating laboratory results to the natural environment.…”

Section: A Biocidal Activity 1 Bacteriamentioning

confidence: 99%

Decontamination technologies for release from bioprocessing facilities. Part IV. Decontamination of equipment/surfaces

Wickramanayake

Sproul

1990

Critical Reviews in Environmental Control

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Long-Term Evaluation of Decontamination of Inhalation-Therapy Equipment and the Occurrence of Necrotizing Pneumonia

Cited by 133 publications

References 24 publications

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

Critical analysis of common canister programs: a review of cross-functional considerations and health system economics

Selektive Darmdekontamination in der Intensivmedizin

Decontamination technologies for release from bioprocessing facilities. Part IV. Decontamination of equipment/surfaces

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