2000 OPEN FORUM Abstracts
WATER SELECTION FOR LARGE VOLUME NEBULIZERS IN THE LONG TERM CARE SETTING
William French, MA, RRT, Kathy Ertter, MT (ASCP), Donna Pfeifer, MT (ASCP), Lakeland Community College, Kirtland, OH
Introduction: In this area many long term care facilities (LTCF) use unheated large volume jet nebulizers (LVN) filled with water as the principal method of providing humidification to residents with tracheostomy tubes. Pressure by recent changes in reimbursement, LTCFs are examining ways to save money. Thus, the question was raised whether distilled water could be used in place of sterile water in the LVNs. In order to determine this, we decided to culture various brands of commercially available distilled water and compare these to sterile water.
Methods: We obtained a new unopened one gallon bottle of each of the following brands of distilled water: Deer Park, Distillata, and Tops. For comparison, we obtained a new unopened 1 Liter bottle of sterile from Baxter (2F7114). A one hundred microliter sample from each bottle was planted on TSA agar with 5% sheep blood. The cultures were incubated at 36 degrees centigrade in a candle jar for approximately 18 hours, then examined. The procedure was repeated after 24 hours on the same water stored at room temperature.
Results: The first set of cultures showed no growth on all plates except #3 (Tops distilled water). The growth pattern on this plate was suspicious of contamination because most colonies grew outside of the streaked area. Approximately four different colony types were seen. The second set of cultures showed no growth on all four plates. Conclusion: On the basis of the negative cultures, we conclude that it is safe to substitute distilled water for sterile water in LVNs. In addition, based on an average cost of $0.20/Liter for distilled water versus $1.23/Liter for sterile water, we calculate a savings of $1.50 to $2.00 per day per LVN, depending on nebulizer flow rate and fluid output of individual LVNs.