1996 OPEN FORUM Abstracts
INCIDENCE OF CONTAMINATION OF METERED DOSE INHALER CANISTERS WHEN USED WITH MULTIPLE PATIENTS USING SPACER DEVICES.
Debi Hinson, RRT. J.L. Rau, PhD, RRT, Department of Respiratory Care, Gwinnett Hospital System, Lawrenceville, GA; Cardiopulmonary Care Sciences, Ga State University, Atlanta, GA.
Introduction: The use of a single MDI canister for multiple patients using spacer devices may offer cost savings to both the patient and the hospital, while promoting direct respiratory care practitioner (RCP) instruction and assessment of aerosolized medication delivery to the patient.
Purpose: Concern for potential cross-contamination prompted a pilot surveillance program to assess the presence of pathogens on MDI canisters being used with spacer devices from multiple patients. Methods: The surveillance was in three phases-Phase I;21 MDI canisters (6 Atrovent, 5 Proventil, 4 Azmacort, 3 Vanceril, 2 Intal and I AeroBid) were collectively used in delivering > 300 MDI treatments to at least 25 different patients over a one week period. A common canister protocol' was followed for these treatments which provides for a single canister to be taken to a patient, the canister nozzle tip wiped with an alcohol prep pad, then inserted into a DHD ACE spacer, and the prescription administered. The same canister was then taken to the next patient, and just prior to administration, the canister nozzle tip was wiped with an alcohol prep pad. The common canister protocol was not used for patients on isolation precautions. At the end of the week, on July 8, 1992 after completing AM. treatment rounds, the 21 canisters were collected, each canister nozzle tip was wiped with an alcohol prep pad to simulate preparation for patient delivery and then environmentally cultured. Phase II: On March 1, 1993, the same process as described in Phase I occurred with 18 canisters and approximately the same treatment/patient volume; however the canister nozzle tips were not wiped with an alcohol prep pad just prior to the culture in an effort to assess the potential results of failure to wipe the canister nozzle tip with an alcohol prep pad prior to patient use. Phase III: On May 10, 1993, the method in Phase I was repeated utilizing 16 canisters whose nozzle tips were cleaned with an alcohol prep pad just prior to the environmental culture.
Results: Phase I: 21/21 cultures resulted in no growth. Phase II: 17/18 cultures resulted in no growth. 1/18 culture resulted in growth of Streptococci Group D Enterococcus. Phase III: 16/16 cultures resulted in no growth. Conclusions: We conclude that cross contamination of MDI canisters to spacer devices is unlikely when following the common canister protocol as described.