Multiple-use atomizers in outpatient otolaryngology clinics are not necessarily an infectious risk

Abstract

Multiple-use atomizers that contain phenylephrine and tetracaine solutions with bacteriostatic preservatives in an outpatient otolaryngology clinic do not yield significant bacterial growth and, when used as described, do not pose an infectious risk of bacterial transmission between patients.

Bacterial contamination of multiple-use atomizers commonly used in Japan

“…Sampling protocols were restrictively designed in the previous studies, which would have resulted in an extremely low rate of bacterial growth from the drug solutions of the atomizer [10,11]. The sampling protocol adopted in the present study is thought to be more realistic as compared with those used in previous studies since in clinical practice the tip of the atomizer nozzle has the possibility of coming in contact with the nasal mucosa or vestibule and hair.…”

“…Several studies have suggested that Venturi principle atomizer devices [3][4][5][6], as well as anesthetic spray applicators [7,8], might be sources of patient cross-contamination Some researchers have advocated single-use disposable nasal sprayers [3], or sterilization of nozzles after each use, or the use of disposable nozzle attachments [6]. It has also been reported that external bacterial contamination of the atomizer nozzle tip resulted in internal bacterial contamination of Venturi devices in as little as one use but not of positive displacement devices [9][10][11][12]. Discrepancies in the results among previous studies are judged to have been caused by the sample protocols used to evaluate cross-contamination of the atomizer.…”

“…Spraggs et al [4] permitted the tip of the nozzle to come in contact with the superior rim of the nasal vestibule. On the other hand, Visosky et al [10] and Scianna et al [11] used a method designed to prevent contact between the atomizer tip and nasal membranes. In the practical use of the atomizer during spraying, a variety…”

Risk of contamination of nasal sprays in otolaryngologic practice

“…In contrast, Visosky and colleagues were unable to demonstrate the significant bacterial colonization of multiple-use atomizers in their outpatient otolaryngology clinic [5]. The authors studied serial dilutions of multidose-drug solutions in the atomizers to minimize the inhibitory effect of antiseptic agents in drug formulations and reported that only 0.6% of the drug solutions yielded bacterial growth (coagulase-negative Staphylococcus ).…”

An unexpected route for otolaryngology bacterial contamination with a Venturi atomizer*

“…Some studies have claimed that there is no risk of cross-contamination of patients with the use of the Venturi system atomizer (5,6) . However, many studies have revealed that after a period of use, bacteria tend to colonize many parts of the Venturi device (7)(8)(9)(10) , which has raised the issue of cross-contamination.…”