Nebuliser hygiene in cystic fibrosis: evidence-based recommendations

Abstract

<jats:p>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.</jats:p><jats:sec><jats:title>Educational aims</jats:title><jats:list list-type="bullet"><jats:list-item><jats:p>To understand the reasons why nebuliser hygiene is important.</jats:p></jats:list-item><jats:list-item><jats:p>To give an overview of the current nebuliser care instructions that have been described by manufacturers, societies and the scientific literature.</jats:p></jats:list-item><jats:list-item><jats:p>To outline the current nebuliser hygiene practices used by persons with cystic fibrosis in the home and hospital settings.</jats:p></jats:list-item><jats:list-item><jats:p>To highlight areas that need further evaluation to promote optimum nebuliser care.</jats:p></jats:list-item><jats:list-item><jats:p>To establish an evidence-based guideline for nebuliser hygiene in relation to cystic fibrosis.</jats:p></jats:list-item></jats:list></jats:sec>

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

“…27,28 These studies emphasize that while drying is a very important step, it is not enough for absolute elimination of NTM and S. aureus. 22 In our study, 48% of participants were using inappropriate places for nebulizer storage, which decreased to 12.1% following training.…”

“…Since it is a cheap, user friendly and accessible method has been more commonly used in recent years. 22,23 Although relatively high percentage of patients reported doing both cleaning and disinfection; only a few participants have been following entire process according IPC guidelines before the education. It is also important to emphasize that self-reported care of nebulizers does not necessarily translate into daily practice.…”

Steam disinfection of toothbrushes from patients with cystic fibrosis: Evidence‐based recommendations

“…CF nebulizer devices have also been shown to be a source of respiratory pathogens 10 and guidelines have been published which address nebulizer cleaning and disinfection, to ensure that such devices are not the origin of respiratory infection/reinfection 11,12 . In regulatory terms, manual toothbrushes (Regulation Number 872.6855) are considered class 1 devices by the Food and Drug Administration, with low to moderate risk, accompanied with General Controls (https://www.fda.gov/medical-devices/overview-device-regulation/regulatory-controls), whereas nebulizers (Regulation Number 868.5630) are considered class 2 devices, accompanied with General Controls and Special Controls (https://www.fda.gov/medical-devices/overview-device-regulation/classify-your-medical-device)…”

“…8,9 CF nebulizer devices have also been shown to be a source of respiratory pathogens 10 and guidelines have been published which address nebulizer cleaning and disinfection, to ensure that such devices are not the origin of respiratory infection/reinfection. 11,12 Table 1 describes the microbial isolates (n = 80; Gram positive= 33;…”

Nebulizer Care and Inhalation Technique in Children with Cystic Fibrosis

“…There is often confusion on what is the best way to clean and disinfect a nebulizer, an issue that adds extra burden to patients and their families [ 3 , 10 , 11 ]. It has been reported that manufacturers’ instructions are not always consistent with guidelines for CF patients and that patients receive conflicting information from different sources [ 6 , 12 , 13 , 14 ]. This evidence underlines the importance of healthcare providers reviewing instructions with CF patients and their families.…”