Nebuliser cleaning and disinfection practice in the home among patients with cystic fibrosis

MacFarlane, Mary; Carson, Lesley; Crossan, Amanda; Bell, Jane; Moore, John E.; Millar, B. Cherie

doi:10.1177/1757177419855603

Cited by 12 publications

(12 citation statements)

References 26 publications

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“…1 The delivery of nebulized therapy is an important component of the care in patients with CF, in which this modality is used to effectively deliver, mainly, antibiotics and mucolytic agents. 2 Proper maintenance of the nebulizer in terms of ensuring that its performance is maintained optimally as well as ensuring that devices are effectively cleaned and disinfected becomes an important element of nebulized therapies.…”

Section: Introductionmentioning

confidence: 99%

Importance of Nebulizer Drying for Patients With Cystic Fibrosis

Moore

Moore²,

Bell³

et al. 2020

Respir Care

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BACKGROUND: Nebulizer therapy is an important treatment component for patients with cystic fibrosis (CF). Nebulizer manufacturers' guidelines advocate thorough nebulizer drying after washing. The aim of this study, therefore, was to examine the microbiology associated with nebulizer drying, particularly related to Pseudomonas control, and to examine microbiologically non-adherence to the recommended drying procedures. METHODS: Four aspects of nebulizer drying were examined in 3 common nebulizers, including examination of the drying profile, improvement to the drying profile of assembled nebulizers, survival of Pseudomonas aeruginosa in tap water and in tap water plus 0.5% (v/v) dishwashing detergent, and the effect of drying of P. aeruginosa in tap water and tap water plus residual sputum (1%v/v, 10%v/v). Microbiologic examination was performed by using P. aeruginosa (5 clinical CF strains plus 1 National Collection of Type Cultures Reference strain). RESULTS: There were differences in the time to complete dryness between disassembled and fully assembled nebulizers. Vigorous repeated shaking was unable to drive off all residual water on assembled nebulizers. P. aeruginosa counts did not decrease significantly in either tap water or in tap water plus detergent after 24 h storage at ambient temperature. In contrast, all Pseudomonas organisms were killed when nebulizers were dried for 24 h, even when contaminated with 1% and 10% sputum. Dishwashing detergent did not demonstrate any antibacterial activity. CONCLUSIONS: This study demonstrated that nebulizer drying, if applied properly, had the ability to reduce counts of P. aeruginosa to non-detectable levels. Equally, this study showed that, if the device was not dried thoroughly and moisture remained, then the device was able to support the survival of P. aeruginosa at high numbers, which constituted an infection risk to the patient with CF. This information may help educate and inform the patient with CF about the importance of proper nebulizer drying for Pseudomonas control to improve patient awareness and safety.

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Section: Introductionmentioning

confidence: 99%

Importance of Nebulizer Drying for Patients With Cystic Fibrosis

Moore

Moore²,

Bell³

et al. 2020

Respir Care

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“…Besides, none of the adult patients reported disinfecting nebulizers on a daily basis. 20 Even though only 5 of 22 adult patients were primarly responsible for nebulizer care in our study, nebulizer disinfection frequency after each use or daily was only 22.7% in the entire adult group. These results may suggest that adult patients may need more attention and support for adherence to treatment, especially before transition from pediatric to adult care.…”

Section: Discussionmentioning

confidence: 52%

The effects of nebulizer hygiene training on the practices of cystic fibrosis patients and caregivers

Yeğit

Ergenekon

Mursaloglu

et al. 2021

Pediatric Pulmonology

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Background: Nebulizers can be contaminated with microorganisms and may be a source of infection in the lower airways in patients with cystic fibrosis (CF).Objective: Primary aim of this study was to determine the level of knowledge regarding nebulizer hygiene and adherence to CF foundation infection prevention and control (IPC) measures of CF patients in our center. We also evaluated the effect of a standardized training program on nebulizer cleaning and disinfection practises with pre and posttest.Methods: Caregivers of 173 CF patients followed at Marmara University CF Center filled a questionnaire (pretest) regarding nebulizer hygiene and received didactic education including pictures and videos based on the cystic fibrosis foundation (CFF) IPC guidelines, patients were also provided educational materials. Posttest was performed 1-3 months after the education session.Results: Following standardized training, usage of appropriate methods according to CFF IPC guidelines improved significantly. Frequency of nebulizer cleaning after each use increased from 58.4% to 78% (p < .01) and disinfection frequency after each/daily usage increased from 33.6% to 75.7% (p < .01). Additionally, methods of cleaning and storage of the nebulizer, also improved significantly (p < .01, p < .01). Conclusion:Education was highly effective to increase the rate of proper practices for nebulizer hygiene. The necessity of cleaning, disinfection, careful drying, correct storage of the nebulizer parts, and changing the nebulizer equipment within recommended time should be emphasized to CF families regularly.

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“…There have been numerous reports of nebuliser hygienic practices in the home that have highlighted that each individual has their own ideas about how to clean and disinfect their nebuliser in terms of frequency of cleaning, washing, drying, disinfection and storage of nebulisers [ 7 , 14 , 15 , 24 ]. One of the earliest studies concluded that respiratory therapists should immediately address and improve their nebuliser cleaning methods and replacement practices with more focus on teaching patients these practices [ 25 ].…”

Section: Experiences Of Nebuliser Hygiene At Homementioning

confidence: 99%

Nebuliser hygiene in cystic fibrosis: evidence-based recommendations

Bell

Alexander

Carson

et al. 2020

Breathe

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Nebulised therapies are extensively used in the daily therapeutic management of cystic fibrosis both for mucociliary clearance and for the management of chronic infections. Extensive developments have been made in relation to nebulised drug delivery mechanisms and drug formulations, and guidelines have been prepared that have addressed the appropriate use of such therapies. However, due to these developments, a plethora of nebuliser devices and drug chambers exist, and frequently, the limited guidance provided in relation to nebuliser hygiene is to follow manufacturers' instructions. Such instructions are inconsistent and at times confusing, translating to an increase in the burden associated with nebuliser maintenance. An evidence-based universal guideline relating to nebuliser care and hygiene is urgently required that is applicable to both at-home use and inpatient use. This article reviews the scientific literature in order to propose an evidence-based approach to nebuliser hygiene to ensure optimum drug delivery, and infection prevention and control.Educational aimsTo understand the reasons why nebuliser hygiene is important.To give an overview of the current nebuliser care instructions that have been described by manufacturers, societies and the scientific literature.To outline the current nebuliser hygiene practices used by persons with cystic fibrosis in the home and hospital settings.To highlight areas that need further evaluation to promote optimum nebuliser care.To establish an evidence-based guideline for nebuliser hygiene in relation to cystic fibrosis.

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Nebuliser cleaning and disinfection practice in the home among patients with cystic fibrosis

Cited by 12 publications

References 26 publications

Importance of Nebulizer Drying for Patients With Cystic Fibrosis

Importance of Nebulizer Drying for Patients With Cystic Fibrosis

The effects of nebulizer hygiene training on the practices of cystic fibrosis patients and caregivers

Nebuliser hygiene in cystic fibrosis: evidence-based recommendations

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